Consent to Telehealth

SCRIPTABLE CONSENT TO TELEHEALTH

Last Updated: June 10, 2026

This Consent to Telehealth (“Consent”) explains the nature of telehealth services provided through the Scriptable platform and obtains your informed consent to receive care through asynchronous telehealth. Please read this document carefully. By checking the consent box during registration, you acknowledge that you have read, understood, and agree to this Consent.

This Consent is subject to Scriptable’s Terms and Conditions and Privacy Policy. Scriptable LLC provides technology infrastructure only. All clinical care is provided by independent licensed healthcare providers affiliated with a separate medical entity (the “Medical Entity”).

1. WHAT IS TELEHEALTH?

Telehealth refers to the delivery of healthcare services using electronic communications technologies, including the internet, video conferencing, and asynchronous messaging. Scriptable’s platform uses asynchronous telehealth, meaning healthcare providers review your submitted intake information—including your medical history, photographs, and questionnaire responses—and make clinical decisions without a real-time video or phone visit.

2. NATURE OF ASYNCHRONOUS CARE

Scriptable uses asynchronous telehealth, in which you complete an intake questionnaire and, where relevant, submit photographs or other information, and a licensed Provider reviews that information to determine whether treatment is appropriate. There is no real-time interaction unless your Provider initiates follow-up communication through the patient portal. You understand and agree that:

• Your care will be provided based on the information you submit, without a real-time examination

• The accuracy and completeness of your submitted information directly affects the quality of your care

• Providers may request additional information before making a clinical decision

• Asynchronous telehealth is not appropriate for urgent or emergency medical needs

3. PROVIDER QUALIFICATIONS

Providers available through the Services include licensed physicians (MDs and DOs), nurse practitioners (NPs), and physician assistants (PAs) who hold active, unrestricted licenses in the state(s) in which they practice. All Providers practice through the affiliated Medical Entity. You may request information about your Provider’s credentials by contacting support@scriptable.co.

4. CONDITIONS APPROPRIATE FOR TELEHEALTH

Telehealth is appropriate for certain conditions where a physical examination is not required for diagnosis or treatment. The conditions addressed through Scriptable’s platform include dermatology (acne, hyperpigmentation, skin texture concerns), hair loss, sexual health, and weight management. Providers exercise independent clinical judgment to determine whether asynchronous telehealth is appropriate for your specific situation. If your Provider determines that in-person care is more appropriate, you will be referred accordingly.

5. LIMITATIONS OF TELEHEALTH

Telehealth has limitations compared to in-person care. You acknowledge and understand that:

• Providers cannot physically examine you

• Information transmitted may be incomplete or insufficient for clinical decision-making in some circumstances

• Technical failures could interrupt or delay care delivery

• Telehealth is not appropriate for emergencies or conditions requiring immediate in-person evaluation

• A Provider who has not met you in person may not be able to provide a complete assessment

If at any time you experience a medical emergency, call 911 or go to the nearest emergency room.

6. BENEFITS OF TELEHEALTH

Telehealth offers significant benefits, including access to licensed Providers without the need for an in-person appointment, convenience of care from your home, faster access to treatment for appropriate conditions, and the ability to receive care regardless of your proximity to a specialty clinic.

7. YOUR RESPONSIBILITIES

By using the Services, you agree to:

• Provide complete, accurate, and truthful information in all intake forms

• Disclose all current medications, allergies, and relevant medical history

• Inform your Provider if your health status changes

• Contact us or your Provider if you experience side effects or have concerns about your treatment

• Notify Scriptable if you move to a different state, as your eligibility for Services may be affected

• Maintain your own primary care relationship for conditions beyond the scope of telehealth

8. PRESCRIPTIONS AND MEDICATIONS

Providers may, at their sole clinical discretion, issue prescriptions for treatments through the affiliated Medical Entity. Prescriptions are fulfilled by our licensed partner pharmacy. You understand that:

• A prescription is not guaranteed as a result of completing an intake

• Compounded medications are not FDA-approved drug products and have not been individually evaluated by the FDA for safety, efficacy, or quality

• You should follow all instructions provided with your medication and contact your Provider with any concerns

• You must inform your Provider of any other medications you are taking to avoid drug interactions

9. GLP-1 AND WEIGHT MANAGEMENT MEDICATIONS

If you are seeking treatment for weight management, you may be prescribed a compounded GLP-1 receptor agonist (such as semaglutide or tirzepatide). These medications carry FDA-required warnings, including:

• Risk of thyroid C-cell tumors, including thyroid cancer (observed in animal studies)

• Contraindication for individuals with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)

• Pancreatitis risk

• Gallbladder disease risk

• Potential teratogenic effects; not recommended during pregnancy or breastfeeding

By requesting weight management treatment, you confirm that you have disclosed your complete medical history, including any history of thyroid cancer or related conditions, and that you are not currently pregnant or breastfeeding.

10. IDENTITY VERIFICATION

To protect patient safety and comply with telehealth regulations, you may be required to verify your identity before receiving care. Identity verification may include submission of a government-issued ID and a selfie photograph. Your identity information is used solely for verification purposes and handled in accordance with our Privacy Policy.

11. GEOGRAPHIC AND JURISDICTIONAL REQUIREMENTS

Telehealth services are subject to the laws of the state in which you are located at the time of your consultation. At the time of your consultation, you must be physically present in the same state in which you are a resident. You represent that you are physically located in a state where Scriptable and the affiliated Medical Entity are authorized to provide services at the time you use the Services.

12. PRIVACY AND HEALTH INFORMATION

Health information you provide is collected and used as described in Scriptable’s Privacy Policy and Consumer Health Data Privacy Notice. Clinical information shared with Providers is handled in accordance with applicable law. The affiliated Medical Entity, as a HIPAA covered entity, will provide you with a Notice of Privacy Practices governing the use and disclosure of protected health information in connection with your clinical care.

13. RISKS OF ELECTRONIC COMMUNICATION

Electronic transmission of health information carries certain risks, including the possibility of interception, system failures, and unauthorized access. Scriptable implements security measures to protect your information, but no system is completely secure. By using the Services, you accept the inherent risks of electronic communication.

14. RIGHT TO WITHDRAW CONSENT

You may withdraw this consent at any time by notifying us at support@scriptable.co. Withdrawal of consent will prevent you from accessing telehealth services through the platform but will not affect care you have already received. Withdrawal does not affect any rights or obligations that arose before withdrawal.

15. NO EMERGENCY CARE

Scriptable does not provide emergency medical care. If you are experiencing a medical emergency, call 911 immediately or go to the nearest emergency room. Do not use the platform to seek care for emergencies.

16. FOLLOW-UP CARE

Providers may recommend follow-up care, referrals, or additional testing as part of your treatment. You are responsible for following up on these recommendations. Scriptable and its Providers are not responsible for outcomes resulting from your failure to follow clinical recommendations.

17. OPEN PAYMENTS DATABASE

Under the federal Physician Payments Sunshine Act, certain payments and transfers of value made to physicians and teaching hospitals must be reported to the Centers for Medicare & Medicaid Services (CMS) and are publicly disclosed in the Open Payments database (openpaymentsdata.cms.gov). If any reportable payment or transfer of value is made to a Provider in connection with your care, it may be required to be disclosed under applicable law.