Telehealth Consent

Consent to Telehealth Services

The client ("Client") voluntarily consents to receive telehealth services from the Practitioner ("Practitioner") through Formulated Health LLC d/b/a Daodi, including video consultation, remote wellness assessment, discussion of symptoms and health history, and care planning, as permitted by applicable law in the State of Maine.

Telehealth services may be provided using interactive audio, video, or other electronic communications technologies and may not be identical to in-person services. The Practitioner will exercise professional judgment in determining whether a telehealth encounter is appropriate and whether the Client should be referred for in-person evaluation, emergency care, or other services.

Telehealth services may involve limitations, including disruptions, delays, technical failures, loss of privacy, and limits on the Practitioner's ability to fully assess the Client without a physical examination. The Client agrees to provide accurate, complete, and current information and to follow instructions regarding the platform, environment, and any recommended follow-up care.

Telehealth services are intended for wellness assessment and care planning and do not guarantee any outcome. The Practitioner does not provide emergency services through telehealth; in an emergency, the Client will call 911 or seek immediate in-person medical attention.

The Client consents to the use and disclosure of the Client's information as necessary to provide telehealth services, maintain records, coordinate care, comply with legal obligations, and as permitted by applicable privacy policies and laws. Electronic communications carry certain privacy and security risks; reasonable safeguards will be used, but no system can be guaranteed completely secure.

The Client may decline or withdraw consent at any time by notifying the Practitioner or Formulated Health LLC d/b/a Daodi, subject to limitations imposed by law, professional obligations, or follow-up already in progress. Withdrawal may affect continued telehealth care and may require in-person services or referral to another provider.

Scope of Services

The Client consents to telehealth services from the Practitioner through Formulated Health LLC d/b/a Daodi to assess the Client's individual wellness needs related to hormonal and reproductive health. Services may include intake, review of health history, discussion of symptoms and goals, wellness consultation, education, recommendations, and other services within the Practitioner's scope of practice and permitted by applicable law.

If clinically appropriate and authorized by the Client, the Practitioner may recommend a custom herbal granule formula, which may be compounded and shipped on a monthly subscription basis, subject to the Client's authorization, applicable law, product availability, and any separate terms governing ordering, billing, shipment, cancellation, or renewal. Optional follow-up consultations may be scheduled but are not guaranteed unless separately arranged.

The Practitioner will exercise professional judgment within the Practitioner's lawful scope of practice. Nothing in this consent requires the Practitioner to provide any service that is outside that scope, contrary to applicable law, or clinically inappropriate in the Practitioner's judgment.

Formulated Health LLC d/b/a Daodi may facilitate scheduling, communications, recordkeeping, billing, subscription administration, and shipment coordination. The Client authorizes the sharing of information among the Practitioner and Formulated Health LLC d/b/a Daodi as reasonably necessary to provide and administer the services, subject to applicable privacy laws and any separate privacy notices or authorizations.

Risks and Benefits of Remote Care

The Client understands that telehealth services may offer benefits, including greater convenience, improved access to care, reduced travel time and associated costs, and the ability to obtain timely follow-up consultations and continuity of care.

The Client further understands that telehealth services also involve certain risks and limitations, including, without limitation:

• the possibility of technical failures, interruptions, poor image or sound quality, or other communication problems that may affect the quality of care;
• the risk of miscommunication or misunderstanding because the Practitioner may not be able to observe all relevant physical findings, nonverbal cues, or environmental conditions;
• the inability of the Practitioner to perform a complete in-person examination, palpation, or other hands-on assessment that may be clinically useful or necessary;
• the possibility that the Practitioner may be unable to identify or evaluate certain conditions, symptoms, or complications remotely with the same accuracy as in person;
• the possibility of delays in diagnosis, treatment, referral, or emergency intervention if the Client's condition requires in-person evaluation or immediate care; and
• the possibility that recommendations, including any recommendation for a custom herbal granule formula on a monthly subscription basis or follow-up consultations, may need to be modified, postponed, or discontinued based on information not fully available through telehealth services.

The Practitioner may determine that an in-person evaluation, referral to another provider, or additional testing is necessary before continuing or modifying care. The Client agrees to cooperate and understands that failure to do so may limit the Practitioner's ability to provide safe and effective care.

Technology Limitations

Telehealth services depend on technology and communications systems outside the control of the Practitioner and Formulated Health LLC d/b/a Daodi, including the Client's internet connection, device hardware and software, and the availability, performance, and security of third-party networks and platforms.

The quality, continuity, and effectiveness of telehealth services may be affected by insufficient bandwidth, poor audio or video quality, dropped calls, delayed transmission, device malfunction, software incompatibility, power outages, platform interruptions, or other technical failures.

The Client agrees to take reasonable steps to support a successful visit, including using a compatible device, maintaining a stable internet connection, and participating from a private, quiet location when feasible. If technical difficulties materially interfere, the Practitioner may continue the visit, reschedule, or recommend an alternative mode of care.

Neither the Practitioner nor Formulated Health LLC d/b/a Daodi guarantees uninterrupted, error-free, or secure transmission of information. The Client remains responsible for promptly communicating any urgent or worsening symptoms through appropriate emergency or in-person channels.

Emergency Instructions

Telehealth services are not appropriate for emergencies or urgent, life-threatening conditions. If the Client experiences chest pain, difficulty breathing, severe bleeding, loss of consciousness, signs of stroke, suicidal thoughts, or any other urgent or life-threatening symptoms, the Client must immediately call 911 or the local emergency number, or go to the nearest emergency department or urgent care facility.

The Practitioner and Formulated Health LLC d/b/a Daodi are not emergency services providers and do not monitor the Client continuously. If the Client is uncertain whether a condition is an emergency, the Client should err on the side of caution and seek immediate in-person emergency medical attention.

If the Client is unable to safely contact emergency services, the Client should seek assistance from a nearby person to obtain emergency help without delay, and is encouraged to keep emergency contact information readily available before participating in telehealth services.

How to Contact the Practitioner or Company

The Client may contact the Practitioner or Formulated Health LLC d/b/a Daodi for scheduling, follow-up questions, technical support, or concerns regarding telehealth services or any custom herbal granule formula using the contact methods provided at booking, in the Client portal, on the website, in appointment confirmations, or in other written communications.

Available channels include: (a) secure messaging through the platform or Client portal; (b) email support@daodi.co; and (c) such other methods as Formulated Health LLC d/b/a Daodi may designate. The Client acknowledges that response times may vary and that immediate responses are not guaranteed outside scheduled consultations or normal business hours.

The Client should promptly contact the Practitioner or Formulated Health LLC d/b/a Daodi with questions about a recommended formula, including use, shipping, billing, refill timing, or whether to continue, modify, pause, or discontinue it, and should report any adverse reaction, unexpected effect, or concern related to the services or any herbal product.

Communications sent by ordinary email or text may not be secure or confidential; the Client should use secure messaging or other designated channels for sensitive information when available. These contact methods should not be used for emergencies; in an emergency, the Client should call 911 or seek immediate in-person medical attention.

Formulated Health LLC d/b/a Daodi may update its contact information, support channels, and communication procedures from time to time by notice to the Client through the platform, website, email, or other reasonable means.

Follow-Up Consultations

Following the initial consultation, optional follow-up consultations may be scheduled to review the Client's progress, discuss changes in symptoms or wellness goals, and, if appropriate in the Practitioner's judgment, adjust recommendations, including any custom herbal granule formula.

Follow-up consultations are not guaranteed and are offered only when the Practitioner determines they are clinically or professionally appropriate and permitted under applicable law. Their availability, timing, format, and frequency may be limited by scheduling, the Client's responsiveness, and Formulated Health LLC d/b/a Daodi's operational requirements.

If the Client is receiving a custom herbal granule formula on a monthly subscription, follow-up consultations may assess whether modification, continuation, pause, or discontinuation is appropriate. Any change remains subject to the Practitioner's judgment, applicable law, and any additional consent or authorization required by Formulated Health LLC d/b/a Daodi or the dispensing pharmacy or compounding facility.

Subscription and Shipping of Herbal Formula

If the Practitioner recommends a custom herbal granule formula, it may be compounded and shipped directly to the Client on a monthly subscription basis, subject to the program terms, the Practitioner's professional judgment, product availability, applicable law, and any instructions communicated by Formulated Health LLC d/b/a Daodi or the Practitioner.

The formula, if ordered, is prepared based on the Client's reported condition, consultation information, and the Practitioner's assessment, and may be modified, paused, or discontinued by the Practitioner, Formulated Health LLC d/b/a Daodi, or the Client in accordance with the program terms and any applicable cancellation or change procedures.

The Client authorizes Formulated Health LLC d/b/a Daodi, the Practitioner, and their service providers to process the Client's order information, arrange compounding, and facilitate shipment to the Client's designated address. The Client is responsible for providing and promptly updating accurate, complete, and current shipping and contact information.

Shipment timing may vary and recurring shipments are not guaranteed to occur on an exact calendar date. Shipping may be delayed, suspended, or canceled due to clinical review, payment issues, inventory constraints, regulatory requirements, carrier delays, weather, or other circumstances beyond reasonable control.

If the Client elects recurring delivery, the Client authorizes recurring charges in accordance with the applicable pricing, billing, and subscription terms disclosed at enrollment or thereafter as permitted by law.

The formula is provided only as part of the telehealth services and is not a substitute for emergency care; the Client should seek immediate medical attention for any urgent or severe symptoms. The Client agrees to review all product instructions, warnings, and accompanying materials and to use the formula only as directed.

Client Acknowledgment

The Client has been informed of, understands, and voluntarily consents to receiving telehealth services from the Practitioner through Formulated Health LLC d/b/a Daodi, which may include consultation, assessment, education, recommendations, follow-up consultations, and related communications conducted by interactive audio, video, or other electronic communications technologies.

Telehealth services are not a substitute for in-person evaluation or emergency care, and the Practitioner may determine that an in-person visit, referral, laboratory testing, or other evaluation is necessary or more appropriate. The availability, scope, and suitability of telehealth services may depend on the Client's condition, the information provided, applicable law, and technological limitations.

Alternatives to telehealth services may include in-person care, consultation with another qualified provider, delaying care until an in-person appointment is available, or seeking emergency services if the situation is urgent. The Client has had the opportunity to ask questions about the process, services, benefits, limitations, and alternatives, and all questions have been answered to the Client's satisfaction.

The Client is responsible for providing accurate, complete, and current information, including health history, symptoms, medications, allergies, and any changes in condition, and for promptly reporting adverse reactions, worsening symptoms, or other concerns.

Telehealth services may involve certain risks, including delays in diagnosis or treatment, technical failures, interruptions, unauthorized access to electronic communications, and limitations arising from the inability to perform a hands-on physical examination. No guarantee has been made regarding outcome or effectiveness.

The Client confirms the Client is in a setting suitable for telehealth services, has access to the necessary technology or assistance, and will take reasonable steps to maintain privacy during the consultation. The Client may withdraw consent at any time, subject to applicable law and the effect on ongoing care.

Formulated Health LLC d/b/a Daodi facilitates the administrative and technological aspects of the telehealth services and does not itself provide medical advice, diagnosis, or treatment unless expressly acting through the Practitioner as permitted by law. The Practitioner remains responsible for the professional services rendered within the scope of the Practitioner's licensure and applicable law.

The Client confirms that the Client has read this acknowledgment, understands its contents, and consents to proceed with telehealth services.