Consent to Telehealth
Introduction
This Consent to Telehealth (“Consent”) applies to all telehealth services provided by Sparks Medical Corp, doing business as Weight Unlocked (“Weight Unlocked,” “we,” “us,” or “our”). Our providers are licensed in the states of California, Washington, Nevada, and Hawaii, and are authorized to provide telemedicine services to patients physically located within those states. By signing this Consent, you (“Patient” or “you”) acknowledge that you understand and agree to receive healthcare services using telehealth technology.
What is Telehealth
Telehealth involves the use of electronic communications—such as video conferencing, secure messaging, or other digital means—to deliver healthcare services when a provider and patient are not in the same physical location. Telehealth may include, but is not limited to:
• Evaluation, diagnosis, consultation, and treatment using electronic communications
• Review of medical records, laboratory data, and test results
• Education and guidance related to your care plan
• Prescription of medications as deemed appropriate by your provider
Potential Benefits
Telehealth allows you to access medical care without the need for travel, increasing convenience, safety, and continuity of care. It enables Weight Unlocked providers to reach patients who may have difficulty attending in-person visits and allows for ongoing follow-up.
Potential Risks and Limitations
As with any medical service, there are potential risks associated with telehealth, including:
• Information transmitted may not be sufficient for diagnosis or treatment decisions
• Technology failures may delay care or result in incomplete transmissions
• In rare cases, security protocols could fail, leading to a breach of privacy
• Telehealth is not a substitute for in-person emergency care or certain physical examinations
Privacy and Confidentiality
All medical information obtained through telehealth will be protected as required by the Health Insurance Portability and Accountability Act (HIPAA) and applicable state privacy laws. Weight Unlocked uses secure platforms and encryption to safeguard your information. However, you acknowledge that no electronic system can be guaranteed to be completely secure. You agree to participate in telehealth from a private, secure environment and to avoid recording or distributing sessions.
Patient Responsibilities
You are responsible for providing accurate, complete, and truthful information to your provider. You should be located in one of the following states during your telehealth visit: California, Washington, Nevada, or Hawaii. You must have access to reliable internet and compatible technology to participate. If your provider believes that telehealth is not appropriate for your condition, you may be asked to schedule an in-person visit.
Financial Responsibility
Weight Unlocked is a cash-pay medical service. Telehealth visits, consultations, and related services are not billed to or reimbursed by insurance. You are financially responsible for all charges incurred and agree to pay the full amount at or before the time of service. We will provide receipts upon request for your records or potential reimbursement claims to your insurer, though coverage is not guaranteed.
Emergency Protocols
Telehealth is not appropriate for medical emergencies. If you are experiencing a medical emergency, you should immediately call 911 or go to the nearest emergency department. You may also contact the National Suicide and Crisis Lifeline by dialing 988 if you are in crisis.
Consent and Acknowledgment
By signing or electronically accepting this Consent, you acknowledge and agree that:
• You understand the nature of telehealth and consent to its use for your medical care.
• You have had the opportunity to ask questions regarding telehealth and this Consent.
• You understand that you may withdraw consent at any time by notifying Weight Unlocked in writing.
• You understand that all medical records from telehealth visits will be maintained by Weight Unlocked.
• You consent to the use of telecommunication technology for healthcare delivery, including the transmission and storage of your medical information.
• You consent to receive follow-up communications electronically, including email or secure message, in connection with your treatment.
Contact Information
For questions, privacy concerns, or withdrawal of consent, please contact us at:
Weight Unlocked
Attn: Privacy Officer
[email protected]
Electronic Signature
By checking the box, typing your name, or otherwise electronically signing through Weight Unlocked’s online system, you affirm that you have read, understood, and agree to this Consent to Telehealth. Your electronic signature has the same legal effect as a handwritten signature.
Effective Date
This Consent to Telehealth is effective as of October 10, 2025.