Telehealth Informed Consent

Last Updated: June 14, 2026

By accessing or using Welm’s telehealth services, you acknowledge that you have read, understood, and consent to the terms of this Telehealth Consent.

1. Telehealth Risks

Telehealth services may differ from in-person care. By consenting, you acknowledge the following potential limitations and risks:

• Technology failures or interruptions during service delivery
• Delayed communications between you and your Provider
• Privacy risks inherent in electronic communications, despite reasonable safeguards
• Limitations in the Provider’s ability to assess your condition compared to an in-person evaluation
• The possibility that your Provider may determine that telehealth is not appropriate for your condition and may refer you to in-person care

2. Asynchronous Care

Certain services are delivered asynchronously through questionnaires and secure messaging. Your Provider reviews your submitted information and responds within two (2) business days. Asynchronous care is not appropriate for urgent or emergency medical needs.

3. State Requirements & Store-and-Forward Technology

In certain states, applicable law requires a synchronous interaction between you and your Provider before prescribing. Welm fulfills this requirement through store-and-forward technology, which means your Provider reviews your submitted health information, questionnaire responses, and any submitted images asynchronously in a clinically appropriate manner that satisfies applicable state synchronous consultation requirements. A live audio or video consultation may be requested by you or required by your Provider at any time.

States currently requiring a synchronous consultation step include:

• Alaska
• Delaware
• Hawaii
• Kansas
• Maine
• Mississippi
• Missouri
• Oregon
• Rhode Island
• West Virginia

This list is subject to change based on applicable state law. The current list is also reflected on the State Coverage page.

4. Emergency Care

Telehealth is not appropriate for medical emergencies. If you are experiencing a medical emergency, call 911 or go to your nearest emergency room immediately. Do not use the Welm platform to seek emergency care.

5. Provider Relationship & Continuity of Care

Welm’s clinical protocols are developed under the oversight of Welm’s Medical Director. Your individual care — including evaluation, prescribing, and follow-up — is delivered by independent licensed Providers operating through MD Integrations. The Medical Director does not serve as your treating Provider.

Welm and MD Integrations endeavor to assign a consistent Provider for your ongoing care. In the event your assigned Provider is temporarily unavailable, a qualified associate Provider within the MD Integrations network may be assigned to ensure continuity of care. All chart notes, health history, and prior clinical documentation are available to any treating Provider within the network.

If a dosage change or medication update is clinically indicated, your Provider will notify Welm, as changes may require the pharmacy to dispense a new vial or formulation and may result in additional cost to you. You will be informed before any such change is processed.

6. Prescriptions

Prescriptions are not guaranteed and remain subject to Provider discretion based on your individual health profile. Welm does not guarantee that a prescription will be issued following your intake or any renewal.

7. Prescription Renewals

Prescription renewals are subject to a clinical review by your Provider, which may include an abbreviated health intake questionnaire. Renewal is not automatic and remains subject to your Provider’s clinical judgment based on your current health status. Failure to complete a required renewal intake may delay or prevent shipment of your next refill.

Continued treatment requires successful completion of any required renewal intake questionnaire. No prescription will be issued until your Provider determines that continued treatment remains clinically appropriate. Failure to complete the required renewal intake may delay treatment, prevent prescription renewal, or result in your subscription being placed on Protective Suspension pursuant to the Subscription & Refund Policy.

8. Additional Informed Consent — Soft Disqualifiers

For certain patients, your Provider may require additional informed consent acknowledgment before prescribing. This may apply if your health history includes, but is not limited to:

• Prior or current pancreatitis
• A history of gallstones
• Concurrent use of diabetes medications, including other GLP-1 receptor agonists, insulin, sulfonylureas, or SGLT-2 inhibitors
• Any other condition flagged during intake as a clinical soft disqualifier

Your Provider will present you with relevant risk information and you must affirmatively acknowledge the risks before prescribing proceeds. This step reflects Welm’s commitment to individualized, evidence-based care and does not constitute a disqualification from the program.

9. Florida Patients — Telehealth Bill of Rights

If you are receiving telehealth services in the state of Florida, you have the following rights under Section 456.0502, Florida Statutes:

• The right to know the identity, professional credentials, and licensure status of your treating Provider.
• The right to receive an itemized statement of charges for all services rendered.
• The right to refuse telehealth services at any time without affecting your right to receive future care.
• The right to request an in-person consultation or referral to an in-person provider.
• The right to have your medical records maintained and accessible to you in accordance with applicable law.
• The right to be informed of the limitations of telehealth services, including limitations specific to your condition.

For questions about your rights as a Florida telehealth patient, contact the Florida Department of Health at www.floridahealth.gov or 1-850-245-4444.

Contact

Email: support@welmhealth.com.