CLARITY WELLNESS COACHING, LLC

Telehealth Consent & Medical Service Disclosure

Last Updated: October 25, 2025

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1. Purpose of This Consent

This Telehealth Consent explains how telemedicine services are delivered through the independent licensed medical providers within the Asher Med partner network.

By using this website, completing a medical intake form, or accessing prescription-only therapies, you acknowledge and agree to this Telehealth Consent.

Clarity Wellness Coaching, LLC (“Clarity Wellness Coaching” or “the Company”) is not a medical practice and does not provide medical care, diagnosis, treatment, or prescriptions.

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2. Independent Medical Providers

All clinical services, including but not limited to:

• Reviewing your medical intake

• Determining eligibility

• Approving or denying treatment

• Prescribing GLP-1 medications, peptides, or other therapies

• Setting and adjusting doses

• Monitoring clinical response

are performed solely and independently by licensed medical professionals contracted through the Asher Med telehealth network.

Clarity Wellness Coaching does not employ these providers, supervise them, or influence their clinical judgment.

This structure ensures compliance with New York State Corporate Practice of Medicine (CPOM) laws and all applicable state regulations.

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3. Nature of Telehealth

Telehealth involves the remote delivery of healthcare services through secure electronic communication. Telehealth may include:

• Review of your submitted medical intake

• Evaluation of health history and symptoms

• Provider messaging or follow-up questions

• Prescription of medications when medically appropriate

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4. Risks & Benefits of Telemedicine

You understand that telehealth:

Benefits:

• Convenient and accessible

• Faster provider review

• No in-person appointment required

Risks:

• Technology delays or interruptions

• Possible incomplete assessment compared to an in-person exam

• Miscommunication due to device or connection issues

You may always request in-person medical care from a local provider of your choice.

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5. Your Responsibilities

By submitting a medical assessment, you agree that:

• You will provide complete and truthful medical information.

• You will disclose all medications, allergies, and health conditions.

• You will notify your provider immediately if you experience any side effects.

• You will follow the provider’s instructions for safe use of prescribed therapies.

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6. Provider Intake Review Fee

You understand that:

• Independent providers may charge a $20 medical intake review fee.

• This fee is billed directly by the provider, not by Clarity Wellness Coaching.

• This fee is charged upon submission of your medical intake form.

• The fee is non-refundable once the provider begins review.

• This fee compensates the provider for the time spent evaluating your case.

Clarity Wellness Coaching does not collect or retain the provider’s $20 clinical review fee, and this fee is billed separately by the licensed medical provider.

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7. Prescription Fulfillment & Pharmacies

If approved, prescriptions are:

• Submitted electronically by the provider

• Fulfilled by licensed U.S. pharmacies contracted within the telehealth network

• Shipped directly to you by the pharmacy

Clarity Wellness Coaching never dispenses, handles, or ships medications.

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8. No Medical Advice From Clarity Wellness Coaching

Clarity Wellness Coaching provides:

• Education

• Coaching

• Support

• Behavior guidance

• Program frameworks

• Accountability tools

Clarity Wellness Coaching does not:

• Practice medicine

• Diagnose or treat medical conditions

• Decide your dosing

• Approve or deny prescriptions

• Provide medical monitoring

• Replace your primary care physician

All medical decisions are made solely by the independent licensed providers.

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9. Privacy & Confidentiality

Your medical information is handled per HIPAA standards by the telehealth provider network.

Clarity Wellness Coaching does not access or store your protected health information (“PHI”) beyond what is voluntarily shared for coaching purposes.

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10. Emergency Situations

Telehealth is not intended for emergencies.

If you experience severe or urgent symptoms, call 911 or visit your nearest emergency room.

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11. Consent & Agreement

By submitting your medical intake or requesting telehealth services, you affirm that:

• You have read and understood this Telehealth Consent

• You understand the role of Clarity Wellness Coaching vs. independent providers

• You agree to telehealth services

• You consent to provider billing of the $20 intake fee

• You understand all risks, benefits, and limitations of telemedicine

You may withdraw consent at any time by stopping use of telehealth services, except where the provider has already begun review.