Consent to Telehealth Treatment

Modern Health is a comprehensive digital mental health and wellbeing platform that includes a clinically integrated network of mental health and wellness providers offering coordinated care in a digital setting in order to give people the tools they need to build resilience, proactively engage in their mental health, and get the support they need, when they need it.

By using the app, you have selected one of Modern Health’s affiliated Practices, as defined below, as your mental health and wellness provider for you and, if applicable, your minor children who you register for services through the app. You consent to receiving access to asynchronous digital programs and tools in the app that you may choose to use without ever matching with a licensed provider and/or certified coach, as well as to the services, examinations, and treatment performed and ordered by your licensed providers and/or certified coaches furnished by the Practice. You understand that your mental health and wellness care may be provided by a variety of different types of digital programs and providers, including psychiatrists, therapists, and coaches. You acknowledge that mental health care is not an exact science and that Modern Health does not make any guarantees regarding the services provided through the app or Practice, and you elect to receive services with full understanding of this information. You have the right to withdraw this consent at any time by sending written notice including your name and address through electronic mail to Practice at: Your withdrawal will be effective upon Practice’s receipt of your written notice, except that your withdrawal will not have any effect on any action taken by the Provider in reliance on this consent before Practice received your written notice of withdrawal. Please be aware, however, that withdrawal of this consent may result in the termination of your access to certain services via the Modern Health App and your ability to receive services from Modern Health and Practice. If registering for services for your minor children, you consent to the collection and disclosure of personal information of such minor children for any lawful purpose.

“Practice” shall mean Modern Health Arizona P.L.L.C. if you reside in and are physically located in one of the following states: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington, D.C., West Virginia, Wisconsin, Wyoming.
“Practice” shall mean Modern Health New Jersey L.L.C. if you reside in and are physically located in New Jersey.
“Practice” shall mean Hopkins Telemedicine PLLC if you reside in and are physically located in New York.
“Practice” shall mean Modern Health California, P.C. if you reside in and are physically located in California.
Telehealth Treatment

Practice, its affiliated health care providers, or other members of your care team, including coaches (each, a “Provider”), may arrange for you to connect with Providers and/or provide you with professional services using asynchronous and/or synchronous telehealth technologies (“Telehealth Technology”). If you have questions about use of the Telehealth Technology itself and whether it is appropriate for your condition, the risks associated with using the Telehealth Technology, or the Provider’s credentials and professional background, please ask your Provider. In exchange for your use of the Telehealth Technology to receive care, you acknowledge and agree to the following terms and conditions of this informed consent:

Use of Telehealth Technology. You understand and agree that:
There are many benefits, but also risks associated with receiving care via Telehealth Technology. Benefits include convenience, increased access, and the ability to receive care in your home. Risks are outlined in Section 2 below.