Effective Date: April 26, 2026 Business Name: Elevé Health Co Location: New Jersey, United States

Telehealth Services Consent Form

By submitting a health intake form and proceeding with any program through Elevé Health Co, you acknowledge that you have read, understood, and agree to the following Telehealth Consent.

1. Nature of Telehealth Services

Elevé Health Co facilitates telehealth wellness services through our licensed Medical Director. These services involve the electronic review of your submitted health information to determine the appropriateness of a wellness protocol for your individual needs. All medical reviews are conducted remotely without an in-person examination.

2. Limitations of Telehealth

You understand that telehealth services have inherent limitations compared to in-person medical care. Our Medical Director will review your intake based solely on the information you provide. It is your responsibility to provide complete, accurate, and honest health information. Failure to do so may result in an inappropriate protocol recommendation and could pose health risks.

3. No Emergency Services

Telehealth services provided through Elevé Health Co are not intended for medical emergencies. If you are experiencing a medical emergency, please call 911 or go to your nearest emergency room immediately.

4. Voluntary Participation

Your participation in telehealth services through Elevé Health Co is entirely voluntary. You have the right to withdraw your consent and discontinue services at any time by contacting us at elevehealthco@gmail.com.

5. Privacy & Confidentiality

All personal and medical information submitted through our platform is kept strictly confidential in accordance with our Privacy Policy. Your information will only be shared with our licensed Medical Director and licensed pharmacy partner as necessary to facilitate your care.

6. Accurate Information

You confirm that all information provided in your health intake form is truthful, complete, and accurate to the best of your knowledge. You agree to notify us immediately of any changes to your health status that may affect your protocol.

7. Risks & Benefits

You understand that as with any medical treatment, there are potential risks and benefits associated with the protocols offered through Elevé Health Co. These risks will be communicated to you by our medical team prior to the commencement of any protocol.

8. State Regulations

Telehealth services may be subject to state-specific regulations. By using our services, you confirm that you are located in a state where the receipt of telehealth services and the prescribed compounds are legally permitted.

9. Acknowledgement

By submitting your health intake form, you confirm that:

• You are at least 18 years of age
• You have read and understood this Telehealth Consent
• You voluntarily agree to receive telehealth services through Elevé Health Co
• You understand the limitations and risks associated with telehealth services
• All information you have provided is accurate and complete

Contact Us

For any questions regarding this Telehealth Consent, please contact us at: elevehealthco@gmail.com | Elevé Health Co | New Jersey, United States