IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL 9-1-1 OR GO TO THE NEAREST EMERGENCY ROOM. DO NOT USE THIS PLATFORM FOR EMERGENCY CARE.

IF YOU ARE CONTEMPLATING SUICIDE, CALL 9-1-1 OR THE 988 SUICIDE & CRISIS LIFELINE BY DIALING 9-8-8.

Introduction

You are receiving this Telehealth Consent because you are seeking services from clinicians affiliated with PWNHealth, LLC, PWN Remote Care Services, P.A., or their related professional entities that together comprise the PWN provider organization (collectively, “Providers”), using telehealth technologies facilitated by Everly Health, Inc. and its affiliates (“Everlywell”). Everlywell provides the website, mobile app, and other telehealth technologies (collectively, the “Platform”).

This Telehealth Consent does not modify or supersede any Terms of Use or Privacy Notice of Everlywell or the Providers. The Providers and Everlywell require you to read and understand this Telehealth Consent before using the Platform.

By creating an account, starting a telehealth consultation, clicking “I consent to telehealth,” checking a box to signify your acceptance, or using any other acceptance method presented through the Platform, you confirm that you have reviewed the risks described in this Telehealth Consent and consent to receiving services using telehealth technologies. A record of this Telehealth Consent is maintained in the files of the Provider delivering your services. Your ongoing participation in services provided by Everlywell or the Providers using telehealth technologies serves as an ongoing acknowledgment of your acceptance of this Telehealth Consent.

What Is Telehealth?

Telehealth (or telemedicine—these terms are often used interchangeably) involves delivering health and wellness services using electronic communications, information technology, or other means between a licensed, certified, or registered health care professional in one location and a patient in another location. It may or may not involve a clinical matter or the practice of medicine. Telehealth may be used for diagnosis, treatment, follow-up, and/or patient education.

Telehealth services may involve various modalities, including asynchronous interactions, real-time video and audio encounters, and interactive audio with store-and-forward technology. Telehealth services may also involve the use of artificial intelligence or machine learning tools to support clinical decision-making, including triage, symptom assessment, or treatment recommendations. Any such tools are used under the supervision and direction of your Provider.

This Telehealth Consent informs the patient (“patient,” “you,” or “your”) about the treatment methods, risks, and limitations of using telehealth to meet your health and wellness needs.

What Are the Possible Benefits of Telehealth?

Telehealth can make it easier and more efficient to access health and wellness services. You can obtain services at times that are convenient for you, without an in-office appointment.

What Are the Possible Risks of Telehealth?

The information you transmit to your Provider may not be sufficient to allow for appropriate health or wellness services for your particular needs. Some clinical needs may not be appropriate for a telehealth visit, and your Provider will make that determination. Limitations inherent in the Platform may affect your Provider’s ability to provide health care services to you. In some cases, an in-person physical examination, test, or other procedure not available on the Platform might provide information that is important or relevant to your care. The quality of the information you submit—including any photographs and other data you upload—may also affect the quality of the services your Provider can deliver through the Platform.

The technology needed to interact with your Provider may fail and delay your services. If a technical failure prevents you from communicating with your Provider, you can reach out by:

• Phone: +1 (888) 362-4321, Monday–Friday, 9:00 a.m. to 5:30 p.m. ET

• Email: [email protected]

Because all data is exchanged in digital format, a data breach could increase unauthorized access to your health data. In rare cases, a lack of access to complete medical records and/or the quality of transmitted data could result in adverse drug interactions, allergic reactions, and/or other clinical judgment errors.

You may stop or decline any ongoing services provided by a Provider through the Platform at any time. You acknowledge, however, that the Providers have no obligation for your ongoing care or for the selection of separate services in those circumstances.

Patient Acknowledgments

By accepting this Telehealth Consent, you acknowledge that you understand and voluntarily consent to the following:

1. I give my informed consent to receive medical care and treatment from the Providers via telehealth modalities through the Platform.

2. I confirm that one of the following applies: (a) I am at least 18 years of age and am consenting on my own behalf; (b) I am the parent or legal guardian of a minor receiving services and have legal authority to consent on their behalf; or (c) I am a minor who is legally authorized under applicable law to consent on my own behalf to the services I am seeking (for example, an emancipated minor, or a minor consenting to a category of care for which minor self-consent is permitted, such as treatment for sexually transmitted infections).

3. I have carefully reviewed this Telehealth Consent and understand that there are risks, limitations, and benefits to using telehealth.

4. I understand that I must be located in a state in which my Provider is licensed and qualified to provide the telehealth services.

5. I understand that federal and state law require health care providers to protect the privacy and security of health information. Everlywell and the Providers will take steps to keep my health information confidential and to prevent access by anyone who should not see it. However, I understand that the electronic nature of telehealth services creates a greater risk to the privacy of my health information.

6. I agree and authorize Everlywell and the Providers to collect, use, and share my information—including my identified health information and other information regarding the telehealth exam—for any purposes permitted by law, including treatment, payment, and health care operations.

7. I understand that, in some cases, my Provider may be a nurse practitioner or physician assistant rather than a physician. The identity, professional credentials, specialty (if applicable), and contact information of the Provider delivering the services have been or will be made available to me before, during, and after the provision of services.

8. I understand that persons other than my Provider may be present during the telehealth visit in order to operate the Platform, including, upon request, for language translation assistance. If another person is present, I will be informed of that individual’s presence and role.

9. I understand that the information I provide as part of any telehealth offering is treated as accurate, true, and complete. I understand that I can contact the Provider by phone at +1 (888) 362-4321, Monday–Friday, 9:00 a.m. to 5:30 p.m. ET, or by email at [email protected] to access, amend, or review my health information.

10. I understand that there is no guarantee that I will be given treatment, including a prescription, and that whether a treatment or prescription is appropriate will be determined in the professional judgment of my Provider. I understand that, while telehealth may provide benefits to me, no specific benefits or results can be guaranteed and my condition may not improve.

11. I understand that telehealth services enable coordination and communication with a Provider and do not replace my relationship with any existing health care provider.

12. I understand that there is a risk of technical failures during the telehealth encounter that are beyond the control of Everlywell and my Provider(s). I AGREE TO HOLD HARMLESS EVERLYWELL, THE PROVIDERS, AND THE EMPLOYEES, CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PARENTS, PREDECESSORS, AND SUCCESSORS OF EACH SUCH PARTY FOR DELAYS IN EVALUATION OR FOR INFORMATION LOST DUE TO SUCH TECHNICAL FAILURES.

13. I understand that the Platform makes available a specific set of services and that I may need to seek other resources for my other health needs. There is no guarantee that I will be treated by a Provider. My Provider reserves the right to deny care if, in my Provider’s professional judgment, providing the services is not medically or ethically appropriate. My Provider may therefore determine, in their sole discretion, that my condition is not suitable for treatment using telehealth and that I may need to seek care and treatment in person or from an alternative source. I understand that the Providers, and not Everlywell, are responsible for the quality and appropriateness of the care they render to me, and that they make all clinical care decisions in their independent discretion without the influence of Everlywell.

14. I understand that I cannot obtain emergency care through the services, and that I should call 9-1-1 and seek immediate medical treatment if I am experiencing a medical emergency.

15. I understand that, when using the Platform, I am not always speaking or messaging with my Provider in real time, and that there may be a delay before my messages or information are reviewed. I can use the Platform to request additional information about follow-up care.

16. I understand that I have the opportunity to discuss the use of telehealth—including the health care services, their benefits and risks, and the alternatives to telehealth—with my Provider(s). I have the right to withdraw my consent to the use of telehealth during the course of my care, without prejudice to any future care or treatment and without risking the loss or withdrawal of any health benefits to which I am entitled. I understand, however, that the Providers who deliver health care services via the Platform do not offer in-person treatment.

17. I understand that I have access to my medical record relating to the health care services provided by Providers using the Platform, in accordance with applicable laws and regulations.

18. I understand that, while the Platform may make available pharmacy services coordinated with the health care services, I am able to request any pharmacy of my preference.

19. I understand that my clinical information may be shared with contractors and/or affiliates for scheduling and billing purposes related to the services made available through the Platform.

20. I will not record the telehealth consultation without my Provider’s prior express consent.

21. I understand that I may obtain, at a reasonable cost, a copy of my telehealth treatment records and request that they be shared with my primary care provider or other treating physician by contacting the Provider by phone at +1 (888) 362-4321, Monday–Friday, 9:00 a.m. to 5:30 p.m. ET, or by email at [email protected]. I can have my telehealth record sent to my other health care providers by emailing [email protected] and providing my consent along with my health care provider’s name, address, and phone number.

Communications Consent

By providing your phone number, you provide your prior express written consent (as defined under the Telephone Consumer Protection Act) to be contacted by Everlywell at the number provided via live call, automatic telephone dialing system, AI, artificial or prerecorded voice, or text for purposes related to your telehealth services. Consent is not a condition of purchase. Message and data rates may apply. Message frequency may vary. Not all carriers or devices are supported. Everlywell is not liable for delayed or undelivered messages. To unsubscribe from texts, you must use the keywords STOP, CANCEL, END, QUIT, STOPALL, or UNSUBSCRIBE; other wording may not be recognized by automated systems. You also acknowledge that this means of communication is not considered secure for the transmission of private information.

Record Retention

Your telehealth records will be retained by your Provider in accordance with applicable federal and state record retention requirements. When the applicable retention period expires, your records may be securely destroyed. You may request information about the applicable retention period by contacting your Provider.

Withdrawing Consent

You can withhold or withdraw this consent at any time by emailing [email protected] with that instruction. Otherwise, this consent will be considered renewed upon each new telehealth consultation with a Provider, unless applicable law requires otherwise.

State-Specific Disclosures (as applicable)

The following disclosures are not already covered above and apply to users accessing the Platform to participate in telehealth services in the states listed below.

Colorado

You retain the option to refuse the delivery of services via telemedicine at any time without affecting your right to future care or treatment and without risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. All applicable confidentiality protections apply to the telemedicine services. You have access to all medical information resulting from the telemedicine services as provided by applicable law.

Iowa

Other than the fees charged, the Provider holds no financial interest in any information, products, or services provided to you. Feedback regarding the quality of telehealth services can be submitted by email at [email protected]. To register a formal complaint about a provider, visit the medical board’s website at https://medicalboard.iowa.gov/consumers/filing-complaint.

Maine

Other than the fees charged, the Provider holds no financial interest in any information, products, or services provided to you.

Nebraska

You have the right to refuse to obtain services via telehealth at any time. Refusing will not affect your right to future care or treatment, nor will it result in the loss of any program benefits to which you would otherwise be entitled.

All confidentiality protections that apply to your in-person medical care apply equally to any telehealth consultation.

You have the right to access all medical information and records generated during your telehealth consultation, including provider notes, diagnoses, and any treatment plans. Unless permitted by applicable law, no identifiable images or information obtained during your telehealth consultation will be shared with any other person or entity without your written consent.

New Jersey

To the extent your scheduled Provider is not a physician (which you will be made aware of prior to your appointment), you have the right to request that your telehealth encounter be scheduled with a physician.

Texas

NOTICE CONCERNING COMPLAINTS: Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants, may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 1801 Congress Avenue, Suite 9.200, P.O. Box 2018, Austin, Texas 78768-2018. Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353. For more information, please visit our website at www.tmb.state.tx.us.

AVISO SOBRE LAS QUEJAS: Quejas sobre médicos, así como sobre otros profesionales médicos de la Junta Médica de Texas, incluyendo asistentes médicos profesionales, acupunturistas, asistentes quirúrgicos, tecnólogos médicos en radiología, técnicos radiólogos no certificados, profesionales de cuidados respiratorios, físicos médicos, y perfusionistas se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 1801 Congress Avenue, Suite 9.200, P.O. Box 2018, Austin, Texas 78768-2018. Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353. Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us.

Utah

There are no additional fees charged separately for telehealth services beyond those disclosed at the time of your encounter. To the extent any additional fees apply, you will be informed of those fees and the manner of payment prior to your encounter.

The telehealth services provided through the Platform meet industry security and privacy standards, and, notwithstanding those measures, risks to the privacy of your health information may exist.

The Platform is owned and operated by Everly Health, Inc., located at 5209 Burnet Road, Suite 300, Austin, Texas 78756. For questions or concerns, you may contact Everlywell at [email protected].

Vermont

You are entitled to choose to receive services by audio-only telephone, in person, or through telemedicine, to the extent clinically appropriate. Your election to receive services by audio-only telephone does not preclude you from receiving services in person or through telemedicine at a later date.

While audio-only telephone services offer convenience and accessibility, there are limitations to delivering and receiving health care services in this manner, including the absence of visual information that may be clinically relevant to your care.

In connection with any audio-only telephone consultation, you will be informed of the presence of any other individual who will participate in or listen to your consultation with your Provider, and your permission will be obtained prior to their participation or observation.

Audio-only telephone services may or may not be covered by your health insurance plan. Coverage for audio-only telephone services varies by plan, and not all health plans cover audio-only services. You may have financial responsibility for co-payments, coinsurance, and deductibles depending on your plan’s coverage of audio-only telephone services.

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Last updated: June 30, 2026