MEREWELL HEALTH

Telehealth & General Informed Consent

Effective Date: [10/18/26]

Merewell Health provides virtual healthcare services, including primary care, sick visits, women's health, STI testing, and mental health medication management.

This document explains the benefits, limitations, and responsibilities associated with receiving care through telehealth.

1. Consent to Care

I voluntarily consent to receive healthcare services from Merewell Health through telehealth, including medical evaluations, diagnosis, treatment, prescriptions, and follow-up care when clinically appropriate.

I understand that I may decline or withdraw consent to telehealth services and discuss alternative care options.

2. Benefits & Limitations

Telehealth provides convenient access to healthcare without requiring an in-person visit.

However, certain medical conditions may require laboratory testing, imaging, physical examination, emergency services, or referral to another healthcare provider.

Telehealth may also involve technical interruptions, communication limitations, or privacy and security risks.

3. Patient Location & Eligibility

I understand that my provider must be authorized to practice in the state where I am physically located during my appointment.

Merewell Health provides services to eligible patients located in Rhode Island and Iowa, subject to applicable licensing requirements.

I agree to accurately disclose my physical location during each visit.

4. Privacy & Communication

Merewell Health uses electronic systems designed to protect patient information in accordance with HIPAA and applicable privacy laws.

I understand that electronic communications may involve privacy risks despite reasonable safeguards.

The secure patient portal is the preferred method for nonurgent healthcare communication.

5. Prescriptions & Treatment

I understand that prescriptions and treatment recommendations are based on clinical judgment and applicable laws.

Certain medications or conditions may require additional evaluation, laboratory testing, or in-person care.

Prescriptions are not guaranteed.

6. Insurance & Payment

Merewell Health accepts eligible insurance plans and self-pay patients.

Insurance coverage and patient costs depend on individual plan benefits and applicable payment policies.

Patients may be responsible for copayments, deductibles, coinsurance, or noncovered services, subject to applicable law.

7. Emergencies

Merewell Health does not provide emergency medical services.

For medical emergencies, call 911 or visit the nearest emergency department.

For mental health crises, call or text 988.

If a telehealth appointment is interrupted, the provider may attempt to reconnect or recommend an alternative method of care.

8. Patient Acknowledgment

By agreeing to the Telehealth & General Informed Consent through Merewell Health's patient intake process, I acknowledge that:

  • I have reviewed and understand the information provided.

  • I understand the benefits, risks, and limitations of telehealth.

  • I have had the opportunity to ask questions.

  • I voluntarily consent to receive healthcare services through telehealth.

  • I understand that I may withdraw consent.