You are viewing this form because you have elected to engage in asynchronous telemedicine visits with a Mevo Health healthcare practitioner through the Mevo Health telehealth platform.
Your practitioner is a board-certified physician licensed in your state.

By clicking “I Agree,” I acknowledge that I have read and understand the terms presented below, and understand the risks and benefits of asynchronous telemedicine. By accepting these terms of use, I hereby give my informed consent to participate in asynchronous telemedicine under these terms.

What is Telemedicine?

Telemedicine is the delivery of healthcare services—including examination, consultation, diagnosis, and treatment—through electronic communication technologies when you (the patient) are in a different location than your healthcare practitioner.

The Mevo Health telehealth platform allows you to receive treatment from a healthcare practitioner without having to travel to another location or schedule a separate appointment, helping you avoid long wait times that you might otherwise experience at an in-person visit.

HIPAA Compliance:

‍Mevo Health and the licensed healthcare providers who deliver care through our platform comply with all applicable federal and state privacy laws, including the Health Insurance Portability and Accountability Act (“HIPAA”). Your personal and medical information will be transmitted and stored securely in accordance with these standards.

What is Asynchronous Telemedicine?

Asynchronous telemedicine is one method of delivering telemedicine. It is often referred to as “store-and-forward” communication, where participants submit and collect data at different times.

An example of asynchronous communication is a telemedicine encounter where you send photos, videos, or other information through secure messaging or forms, and your healthcare practitioner reviews and responds later.
“Asynchronous” means “not occurring at the same time” and differs from “synchronous” telemedicine, which takes place in real time (such as a live video or phone consultation).

Healthcare practitioners may use asynchronous telemedicine to aid in diagnosis and consultation when live communication or face-to-face contact is not possible or necessary.

The Mevo Health platform enables the following asynchronous telemedicine services:

Text-based healthcare practitioner–patient interactions through secure messaging, SMS, or MMS communications.

Secure information collection through asynchronous store-and-forward patient questionnaires.

Possible Risks of Using Asynchronous Telemedicine

As with any medical treatment, there are potential risks associated with the use of asynchronous telemedicine.
Mevo Health believes the likelihood of these risks materializing is very low.
These risks may include, without limitation:

Delays in medical evaluation, consultation, or treatment due to deficiencies or failures of the equipment or internet, including poor data quality, outages, or service interruptions. You may reschedule your visit should these interruptions occur.

Security risks, including the unlikely possibility of unauthorized access or breach of personal medical information despite standard security protocols.

Incomplete medical history: because your provider may not have access to your complete medical records, failure to disclose a full list of medical history, treatments, medications/supplements, and allergies could result in adverse reactions or outcomes.

Non-emergency limitation: asynchronous telemedicine services are not emergency services and your personal data will not be monitored 24/7.
If you think you are experiencing a medical emergency, call 911 immediately.

The care you receive will be at the sole discretion of the healthcare practitioner who is treating you.
There is no guarantee of diagnosis, treatment, or prescription. The healthcare practitioner will determine whether your condition is appropriate for care via asynchronous telemedicine on the Mevo Health platform.

Licensure Notice:

‍All healthcare services provided through Mevo Health are delivered by practitioners licensed in the state where you are physically located at the time of your encounter. Care is not available in states where Mevo Health does not currently operate.

Your Rights and Acknowledgements

You have the same privacy rights via asynchronous telemedicine that you would have during an in-person visit.
Dissemination of any identifiable images or information from your asynchronous telemedicine visit to researchers or other entities will not occur without your written consent.

Asynchronous telemedicine may involve the secure electronic transmission of your medical information to healthcare practitioners located in other areas, including out of state.

You understand that you may expect the anticipated benefits from asynchronous telemedicine, but that no results can be guaranteed or assured.

All information submitted to Mevo Health through the platform or by text message will become part of your medical record and may be made available to you upon request by emailing care@mevohealth.com

Your healthcare practitioner’s initial message to you will include their name and credentials, which will be recorded in the Mevo Health platform as part of your medical record.

You may withdraw your consent and request deletion of your patient profile at any time by emailing care@mevohealth.com

Your healthcare information may be shared with other individuals in accordance with the Mevo Health Privacy Policy and applicable state or federal laws.

Your healthcare information may be shared in the following circumstances:

When a valid court order is issued for medical records.

When reporting suspected abuse, neglect, or domestic violence.

To prevent or reduce a serious threat to anyone’s health or safety.

Call/Email/Text Messaging Consent

You expressly consent to allow Mevo Health or its healthcare practitioners to call, email, or text you (via SMS and/or MMS) with or regarding personal data, appointments, or similar matters related to your telemedicine encounters using the contact information you have provided.
Any calls or texts to you may be placed using an auto-dialer or a pre-recorded or artificial voice, even if your number is on a do-not-call list.
Your phone carrier’s normal rates may apply.
This consent is not a condition of purchase, and you may revoke it at any time by emailing care@mevohealth.com

Duration of Consent

This Asynchronous Telemedicine Informed Consent remains valid throughout your entire course of treatment with Mevo Health.