Patriot IV & Pro health Telehealth Consent and Consent to Treat
Last updated: Dec 2025
Results may vary
As with any medical treatment or health-related product or service, results vary from person to person. Outcomes depend on many individual factors, including your health history, current conditions, genetics, other medications, adherence to clinical instructions, lifestyle, and environmental factors.
Any descriptions of potential benefits, improvements, or expected outcomes are not guarantees. Your experience may differ from examples, testimonials, or illustrations.
Informed consent and consent to treat
This Telehealth Consent and Consent to Treat (Consent) explains how telehealth works and obtains your informed consent to receive healthcare services using telehealth technologies.
By checking a box, clicking an “I Agree” button, or otherwise digitally signing or acknowledging this Consent, you confirm that you have read, understood, and agree to it.
If you do not agree, do not create an account and do not use telehealth services.
You also authorize any person who accepts this Consent on your behalf using your device or account credentials to act as your agent for that purpose.
Emergency notice
Telehealth is not for emergencies.
If you are experiencing a life-threatening situation, including chest pain, difficulty breathing, sudden loss of consciousness, severe injury, or thoughts of harming yourself or others, call 911 immediately or go to the nearest emergency room.
You may also call or text the 988 Suicide and Crisis Lifeline by dialing 988.
Purpose
The purpose of this Consent is to:
explain how telehealth works
describe benefits, limitations, and risks
obtain your informed consent to receive healthcare services using telehealth technologies
Parties and roles
Patriot IV LLC (we, us, or our) provides general and non-clinical support for the telehealth experience, including account access support, basic navigation, and administrative assistance.
Clinical services are provided by independent, licensed healthcare professionals and or clinician groups (Providers). Providers are solely responsible for clinical decision-making, including whether telehealth is appropriate, what care to provide, and whether to prescribe medication.
We use a clinical support organization that helps facilitate access to Providers and supports care operations, including routing clinical requests and prescription coordination through the platform (Clinical Support Organization). Patriot IV LLC performs this Clinical Support Organization role.
We are not your treating clinician and do not provide medical diagnosis, treatment, or prescriptions.
Definitions
Telehealth means the use of electronic communications, information technology, or other means to provide healthcare services when you and the Provider are not in the same physical location.
Service means the online portals, websites, mobile applications, messaging tools, scheduling tools, and related technology used to support the telehealth experience.
You or your means the individual patient receiving telehealth services. If a parent or legal guardian is consenting for a minor where permitted by law, you and your also includes the parent or legal guardian.
How telehealth may be used
Telehealth may be used for evaluation, consultation, diagnosis, treatment planning, prescribing decisions, follow-up care, monitoring, and patient education, as determined appropriate by your Provider.
Telehealth interactions may include:
real-time communications by audio and or video
asynchronous communications, such as secure messaging, questionnaires, and intake forms
sharing medical records, photos, images, and other health information between you and your Provider, or between Providers
review of laboratory results, device readings, diagnostic data, and monitoring information
administrative communications for scheduling, prescription management, care coordination, and similar purposes
Your Provider may determine that telehealth is not appropriate for some or all of your needs. In that case, your Provider may advise you to seek in-person care, urgent care, emergency care, or another appropriate channel.
Alternatives to telehealth
Telehealth is one option. It may not be clinically appropriate in all situations.
You may choose in-person care instead of telehealth where available. You may also request an in-person referral or recommendation, although availability depends on your location, your condition, and provider availability.
Anticipated benefits
Telehealth may offer benefits such as:
access to Providers without travel
improved scheduling convenience
continuity of care through follow-up and monitoring
the ability to share information and receive education remotely
You understand that telehealth is not guaranteed to produce any particular result or outcome.
Potential risks and limitations
Telehealth has risks and limitations. Some risks are inherent to receiving care without an in-person exam, and some risks relate to the use of electronic systems.
These risks may include:
limits due to the absence of an in-person examination and inability to perform certain physical tests
the possibility that a condition is not identified, is identified later, or is managed differently than it might be in an in-person setting
reliance on information you provide, which may be incomplete, inaccurate, delayed, or difficult to verify
delays in care due to provider availability, technology issues, incomplete information, or the need for in-person testing
technology failures, including dropped connections, audio or video issues, software errors, device malfunction, and outages
privacy and security risks inherent in electronic communications
regulatory or clinical limitations that may restrict certain services or prescribing in some jurisdictions
By agreeing to telehealth, you accept these risks.
Your responsibilities
To support safe care, you agree to provide accurate, complete, and current information about your symptoms, history, medications, allergies, and prior diagnoses.
You agree to provide requested photos, documents, measurements, and other information when needed. You also agree to promptly review messages and respond to reasonable requests for additional information.
You agree to follow your Provider’s instructions and to seek in-person or emergency care when directed.
You understand that inaccurate or incomplete information may lead to delays, denial of service, adverse drug interactions, allergic reactions, or other harm.
Prescriptions, pharmacies, and medication fulfillment
If your Provider determines that a prescription is appropriate, the prescription may be sent to a participating pharmacy or to a pharmacy you choose where permitted.
Pharmacies are independent third parties and are responsible for dispensing, counseling, fulfillment, shipping, and pharmacy services.
You understand that:
your Provider may decide not to prescribe medication
not all medications are available in all jurisdictions
some medications require lab work, follow-up, or other monitoring
prescription products are generally not returnable
Laboratory testing and diagnostics
Your Provider may require diagnostic testing, including laboratory testing or at-home test kits.
Laboratories and diagnostic providers are independent third parties and are responsible for their services.
You understand that:
tests may produce false positive, false negative, inconclusive, or uncertain results
delays, shipping issues, and specimen handling problems may affect results
your Provider interprets results using professional judgment and may recommend repeat testing or in-person care
Privacy, HIPAA, and electronic communications
Telehealth services and communications may involve sharing personal information and protected health information (PHI).
PHI is generally handled by Providers and their medical groups under applicable health privacy laws, including HIPAA where applicable, and may be described in a Notice of Privacy Practices provided by your Provider or the Provider’s medical group.
In addition, the Service may collect and use certain information for administrative and operational purposes. Information that is not PHI may be governed by the privacy policy located on our website at https://patriotiv.com/.
Some parts of the Service may use secure portals and tools intended to protect PHI. However, certain administrative communications may be sent by email, SMS, phone, or similar methods. These communications may not always be encrypted and may be accessible to your email provider, mobile carrier, or others who have access to your devices or accounts.
You are responsible for protecting access to your devices, email accounts, and communication channels. You understand that no system is completely secure and you accept the risk of unauthorized access that may occur despite reasonable safeguards.
Technical issues, outages, and response times
Providers may not be immediately available. Response times vary.
If you have an urgent issue, seek in-person urgent care or emergency care.
If a technical issue prevents you from using the Service, you may need to reschedule or seek care through another channel. You agree not to delay emergency or urgent care due to a technical issue.
Support contacts
If you need help accessing the Service or have a general and non-clinical support question, contact us at info@patriotiv.com.
If you have a medical question or need help routing a clinical request to your Provider through the Service, you may contact the Clinical Support Organization at support@Patriot IV.io.
Location and eligibility
Telehealth services depend on your physical location at the time of the visit and on Provider licensure and other legal requirements.
You agree to provide accurate information about your current location when requested.
If you travel or are located in a jurisdiction where your Provider cannot legally provide services, your Provider may be unable to treat you.
Consent to treat
You consent to evaluation and treatment by Providers through telehealth. This may include history taking, review of records, counseling, ordering of tests, and prescribing decisions where appropriate.
You understand that your Provider will determine whether telehealth is clinically appropriate.
No guarantees
No guarantees have been made to you about outcomes, prescriptions, appointment availability, response times, or availability of specific medications or services.
Withdrawal of consent
You may withdraw your consent to telehealth at any time by not scheduling or participating in further telehealth encounters.
Withdrawal does not affect actions already taken or information already disclosed before your withdrawal.
Withdrawing consent may limit your ability to receive services through the Service.
Acknowledgment
By accepting this Consent, you acknowledge that:
you have read and understand this Consent
you had an opportunity to ask questions and received satisfactory answers
you understand the benefits, risks, and limitations of telehealth
you consent to evaluation and treatment via telehealth as described above
Signature and electronic acceptance
You agree that your electronic signature, checkbox acceptance, or similar acknowledgment has the same legal effect as a handwritten signature.
You may request a copy of this Consent for your records by contacting us at info@patriotiv.com.
Contact
General and non-clinical support: info@patriotiv.com
Clinical routing support: support@Patriot IV.io