Telehealth Consent

Overview

This Consent to Telehealth Treatment describes how Arilon Corp d/b/a MOY Health (“MOY Health,” “we,” “us,” or “our”) delivers healthcare services through telehealth and what that means for you as a patient. By agreeing to this document, you confirm that you have read, understood, and consent to receive medical services via telehealth.

Nature of Telehealth Services

• Telehealth involves delivering healthcare through electronic communications, including secure messaging and audio or video where applicable.

• Licensed physicians will review your medical history, current health status, and treatment requests to determine whether a prescription or therapy is appropriate for you.

• Depending on your case and physician availability, physicians may communicate with you asynchronously (not in real time) or synchronously (via live chat or video).

• Arilon Corp (d/b/a MOY Health) facilitates access to licensed physicians but does not itself practice medicine. All clinical decisions are made by licensed healthcare professionals.

Eligibility

• You may qualify for treatment if your Body Mass Index (BMI) is 30 or higher, or 27 or higher with at least one weight-related health condition such as high blood pressure, type 2 diabetes, elevated cholesterol, obstructive sleep apnea, or cardiovascular disease.

• If your BMI is above 25, you may still qualify depending on your overall medical history. Eligibility is assessed by a licensed physician following a review of your intake information.

  
  

Risks and Limitations of Telehealth

• Telehealth is not a replacement for in-person medical care in every situation.

• Certain conditions may be difficult to diagnose or treat without a physical examination.

• Technical issues may occasionally disrupt service availability.

• Telehealth cannot be used to manage medical emergencies. If you are experiencing a medical emergency, call 911 immediately.

Compounded Medications Disclosure

• Some prescriptions issued through MOY Health may involve compounded medications. Compounded medications are not approved by the U.S. Food and Drug Administration (FDA) and have not been reviewed by the FDA for safety, effectiveness, or manufacturing quality.

• MOY Health partners exclusively with licensed U.S. compounding pharmacies that operate under strict state and federal oversight and are held to rigorous compounding standards.

• A licensed physician will determine whether a compounded medication is appropriate for your specific situation.

Patient Responsibilities

By consenting to telehealth services through MOY Health, you agree to:

• Provide complete and accurate medical information at all times.

• Notify your physician promptly of any changes to your health status or current medications.

• Follow the treatment plan and clinical instructions provided by your licensed physician.

• Use a secure and private internet connection when accessing telehealth services.

Privacy and Confidentiality

• Your personal health information will be collected, stored, and shared in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

• For full details on how we handle your information, please review our Privacy Policy at trymoy.com/privacy-policy.

Consent

By accepting this Consent to Telehealth Treatment, you confirm that:

• You have read and understood the information set out above.

• You consent to receiving healthcare services via telehealth.

• You understand the risks and limitations associated with telehealth services.

• You understand that MOY Health does not guarantee specific treatment outcomes.

Contact Information

Arilon Corp (d/b/a MOY Health)

30 N Gould St Ste R

Sheridan, WY 82801

support@trymoy.com
(307) 218-3882