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Telehealth Informed Consent

Clear Health™

Last updated: May 20, 2026

Introduction

HelloClearHealth.com (the "Platform") is operated by Nefaire Inc dba Clear Health™ ("Clear Health™"). Clear Health™ provides a technology platform that facilitates communication between patients, independent licensed healthcare providers, pharmacies, laboratories, and other healthcare service providers.

Telehealth services may not be available in all jurisdictions and are subject to provider licensure, state law requirements, clinical appropriateness, and service availability.

Clear Health™ does not practice medicine, provide medical advice, diagnose conditions, prescribe medications, dispense medications, or otherwise direct or control the independent clinical judgment of healthcare providers.

All medical consultations, diagnoses, treatment recommendations, prescriptions, and healthcare services are provided solely by independent licensed healthcare professionals exercising independent clinical judgment.

Telehealth involves the use of electronic communications and information technologies that enable healthcare providers and patients located in different locations to communicate for purposes of evaluation, diagnosis, treatment, monitoring, follow-up care, patient education, prescription management, and healthcare coordination.

Telehealth services offered through the Platform may include chart review, asynchronous communications, image review, remote prescribing, appointment scheduling, health information sharing, patient education, laboratory coordination, and other healthcare-related services deemed appropriate by an independent licensed healthcare provider.

The electronic communication systems utilized by the Platform incorporate commercially reasonable administrative, technical, and physical safeguards designed to protect the confidentiality, integrity, and security of personal and health information.

Healthcare providers utilizing the Platform are intended to supplement, and not replace, the relationship between a patient and their primary care provider. Patients are encouraged to maintain an ongoing relationship with a local primary care provider whenever possible.

Expected Benefits

Potential benefits of telehealth services include:

  • Improved access to healthcare services.
  • Increased convenience and reduced travel requirements.
  • More timely access to licensed healthcare professionals.
  • Enhanced continuity of care and follow-up.
  • Access to specialized expertise when appropriate.
  • Improved communication and coordination of care.

Possible Risks

Potential risks associated with telehealth services include:

  • Delays in evaluation, diagnosis, treatment, or follow-up due to technology failures or interruptions.
  • Incomplete, inaccurate, delayed, or interrupted transmission of medical information.
  • Cybersecurity incidents, unauthorized access, or privacy breaches despite reasonable security measures.
  • Limitations inherent in remote evaluations compared to in-person examinations.
  • The possibility that telehealth may not be appropriate for certain medical conditions.
  • The possibility that a healthcare provider may require an in-person examination, laboratory testing, imaging, specialist referral, emergency evaluation, or discontinuation of telehealth treatment.

In rare circumstances, lack of access to complete medical records or physical examination findings may contribute to diagnostic, treatment, or medication-related errors.

Emergency Medical Situations

THE SERVICES PROVIDED THROUGH THE PLATFORM ARE NOT INTENDED FOR MEDICAL EMERGENCIES. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL 911 OR SEEK IMMEDIATE IN-PERSON MEDICAL ATTENTION IMMEDIATELY.

Healthcare providers utilizing the Platform are not able to directly contact emergency responders on your behalf.

Patient Acknowledgements and Consent

By checking the applicable consent box, creating an account, using the Platform, or participating in telehealth services, you acknowledge and agree to the following:

Telehealth Consent

I voluntarily consent to receive healthcare services through telehealth technologies.

I understand that it is solely the responsibility of the healthcare provider to determine whether my medical condition is appropriate for telehealth treatment.

I understand that alternatives to telehealth services, including in-person care, may be available to me.

Independent Healthcare Providers

I understand that healthcare providers utilizing the Platform are independent licensed professionals and are not employees, agents, partners, or representatives of Clear Health™.

I understand that all diagnoses, prescriptions, treatment recommendations, medication decisions, and clinical determinations are made solely by the healthcare provider exercising independent professional judgment.

I understand that completion of a consultation, payment of fees, participation in telehealth services, or submission of medical information does not guarantee prescription approval, treatment eligibility, medication availability, or any specific medical outcome.

Independent Pharmacies

I understand that pharmacies utilized in connection with my care are independent third parties responsible for prescription dispensing, pharmacy operations, medication counseling obligations, shipping, and compliance with applicable pharmacy laws and regulations.

I understand that pharmacy availability, medication availability, shipping times, and fulfillment decisions may vary.

Where permitted by law and operational workflow, I may have the ability to request a pharmacy preference.

Privacy and Electronic Communications

I understand that healthcare information may be transmitted electronically between healthcare providers, pharmacies, laboratories, and other authorized parties involved in my care.

I understand that while reasonable safeguards are used, no technology system can guarantee complete security.

I understand that I may receive communications related to my care through email, secure messaging, telephone, SMS/text message, or other electronic communication methods, subject to applicable law and Clear Health™ policies.

Technical Failures

I understand that technical failures, interruptions, connectivity issues, software malfunctions, or other technology-related issues may affect telehealth services.

I agree that Clear Health™ shall not be responsible for delays, interruptions, or information loss resulting from technology failures outside of its reasonable control.

Withdrawal of Consent

I understand that I may withdraw my consent to telehealth services at any time by discontinuing use of the Platform and notifying my healthcare provider.

Withdrawal of consent will not affect any treatment or services previously rendered.

Access to Medical Records

I understand that I may have the right to request access to my medical records in accordance with applicable law and healthcare provider policies.

Treatment Outcomes

I understand that treatment outcomes vary among individuals and depend upon numerous factors, including medical history, underlying conditions, treatment adherence, concurrent medications, genetics, and individual biological response.

I understand that no specific medical, cosmetic, or therapeutic outcome is guaranteed.

Additional State-Specific Consents

The following consents apply to users accessing the www.helloclearhealth.com website for the purposes of participating in a telehealth consultation as required by the states listed below (and where necessary they should be interpreted as referring to Patient and not the parent or legal guardian):

  • Alaska: I understand my primary care provider may obtain a copy of my records of my telehealth encounter. (Alaska Stat. § 08.64.364).
  • Arizona: I understand I am entitled to all existing confidentiality protections pursuant to A.R.S. § 12-2292. I also understand all medical reports resulting from the telemedicine consultation are part of my medical record as defined in A.R.S. § 12-2291. I also understand dissemination of any images or information identifiable to me for research or educational purposes shall not occur without my consent, unless authorized by state or federal law. (Ariz. Rev. Stat. Ann. § 36-3602).
  • Connecticut: I understand that my primary care provider may obtain a copy of my records of my telehealth encounter. (Conn. Gen. Stat. Ann. § 19a-906).
  • District of Columbia: I have been informed of alternate forms of communication between me and a provider or other treating dermatologist for urgent matters. (D.C. Mun. Regs. tit. 17, § 4618.10).
  • Georgia: I have been given clear, appropriate, accurate instructions on follow-up in the event of needed emergent care related to the treatment. (Ga. Comp. R. & Regs. 360-3-.07(7)).
  • Kansas: I understand that if I have a primary care provider or other treating dermatologist, the person providing telemedicine services must send within three business days a report to such primary care provider or other treating dermatologist of the treatment and services rendered to me during the telemedicine encounter. (Kan. Stat. Ann. § 40-2,212(2)(d)(1)(A)).
  • Kentucky: If I am a Medicaid recipient, I recognize I have the option to refuse the telehealth consultation at any time without affecting the right to future care or treatment and without risking the loss or withdrawal of a Medicaid benefit to which I am entitled. I understand that I have the right to be informed of any party who will be present at the site during the telehealth consult and I have the right to exclude anyone from being present. I also understand that I have the right to object to the videotaping of the telehealth consultation. (907 Ky. Admin. Regs. 3:170).
  • Louisiana: I understand the role of other health care providers that may be present during the consultation other than the www.helloclearhealth.com affiliated provider. (46 La. Admin. Code Pt XLV, § 7511).
  • Maryland: Regarding audiologists, speech language pathologists, and hearing aid dispensers, I recognize the inability to have direct, physical contact with the patient is a primary difference between telehealth and direct in-person service delivery. The knowledge, experiences, and qualifications of the consultant providing data and information to the provider of the telehealth services need not be completely known to and understood by the provider. The quality of transmitted data may affect the quality of services provided by the provider. Changes in the environment and test conditions could be impossible to make during delivery of telehealth services. Telehealth services may not be provided by correspondence only. (Md. Code Regs. 10.41.06.04).
  • Nebraska: If I am a Medicaid recipient, I retain the option to refuse the telehealth consultation at any time without affecting my right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the patient would otherwise be entitled. All existing confidentiality protections shall apply to the telehealth consultation. I shall have access to all medical information resulting from the telehealth consultation as provided by law for access to my medical records. Dissemination of any patient identifiable images or information from the telehealth consultation to researchers or other entities shall not occur without my written consent. I understand that I have the right to request an in-person consult immediately after the telehealth consult and I will be informed if such consult is not available. (Neb. Rev. Stat. Ann. § 71-8505; 471 Neb. Admin. Code § 1-006.05).
  • New Hampshire: I understand that the www.helloclearhealth.com affiliated provider may forward my medical records to my primary care or treating provider. (N.H. Rev. Stat. § 329:1-d).
  • New Jersey: I understand I have the right to request a copy of my medical information and I understand my medical information may be forwarded directly to my primary care provider or health care provider of record, or upon my request, to other health care providers. (N.J. Rev. Stat. Ann. § 45:1-62).
  • Pennsylvania: I understand that I may be asked to confirm my consent to behavioral health or tele-psych services.
  • Rhode Island: If I use e-mail or text-based technology to communicate with my www.helloclearhealth.com affiliated provider, then I understand the types of transmissions that will be permitted and the circumstances when alternate forms of communication or office visits should be utilized. I have also discussed security measures, such as encryption of data, password protected screen savers and data files, or utilization of other reliable authentication techniques, as well as potential risks to privacy. I acknowledge that my failure to comply with this agreement may result in the www.helloclearhealth.com affiliated provider terminating the e-mail relationship. (Rhode Island Medical Board Guidelines).
  • South Carolina: I understand my medical records may be distributed in accordance with applicable law and regulation to other treating health care practitioners. (S.C. Code Ann. § 40-47-37).
  • South Dakota: I have received disclosures regarding the delivery models and treatment methods or limitations. I have discussed with the www.helloclearhealth.com affiliated provider the diagnosis and its evidentiary basis, and the risks and benefits of various treatment options. (S.D. SB136 (not yet codified)).
  • Tennessee: I understand that I may request an in-person assessment before receiving a telehealth assessment if I am a Medicaid recipient.
  • Texas: I understand that my medical records may be sent to my primary care provider. (Tex. Occ. Code Ann. § 111.005).
  • Utah: I understand (i) any additional fees charged for telehealth services, if any, and how payment is to be made for those additional fees, if the fees are charged separately from any fees for face-to-face services provided in combination with the telehealth services; (ii) to whom my health information may be disclosed and for what purpose, and have received information on any consent governing release of my patient-identifiable information to a third-party; (iii) my rights with respect to patient health information; (iv) appropriate uses and limitations of the site, including emergency health situations. I understand that the telehealth services www.helloclearhealth.com provides meets industry security and privacy standards and comply with all laws referenced in Subsection 26-60-102(8)(b)(ii). I was warned of: potential risks to privacy notwithstanding the security measures and that information may be lost due to technical failures, and agree to hold the provider harmless for such loss. I have been provided with the location of www.helloclearhealth.com's website and contact information. I was able to select my provider of choice, to the extent possible. I was able to select my pharmacy of choice. I am able to a (i) access, supplement, and amend my patient-provided personal health information; (ii) contact my provider for subsequent care; (iii) obtain upon request an electronic or hard copy of my medical record documenting the telemedicine services, including the informed consent provided; and (iv) request a transfer to another provider of my medical record documenting the telemedicine services. (Utah Admin. Code r. 156-1-602).
  • Virginia: I acknowledge that I have received details on security measures taken with the use of telemedicine services, such as encrypting date of service, password protected screen savers, encrypting data files, or utilizing other reliable authentication techniques, as well as potential risks to privacy notwithstanding such measures; I agree to hold harmless www.helloclearhealth.com for information lost due to technical failures; and I provide my express consent to forward patient-identifiable information to a third party. (Virginia Board of Medicine Guidance Document 85-12).
  • Vermont: I understand that I have the right to receive a consult with a distant-site provider and will receive one upon request immediately or within a reasonable time after the results of the initial consult. I understand that receiving tele-dermatology or tele-ophthalmology services via www.helloclearhealth.com does not preclude me from receiving real-time telemedicine or face-to-face services with the distant provider at a future date. (Vt. Stat. Ann. § 9361).

Consent to Treatment

I have carefully reviewed this Telehealth Informed Consent and understand the benefits, risks, limitations, and alternatives associated with telehealth services.

I voluntarily consent to receive healthcare services through telehealth technologies under the terms described herein.

Consent for Minor Patients

If the patient receiving services is under the age of 18, I certify that I am the patient's parent or legal guardian and have legal authority to provide consent on behalf of the patient.

I voluntarily consent to the patient's participation in telehealth services and authorize healthcare providers utilizing the Platform to provide medically appropriate healthcare services to the patient.