Telehealth Informed Consent

1. Purpose of This Consent

This Telehealth Informed Consent ("Consent") provides you with important information about the nature, benefits, risks, and limitations of telehealth services provided by Bloom360, Inc. ("Bloom360," "we," "us," or "our"). By using our Services and accepting this Consent, you acknowledge that you have read, understood, and agree to the terms described herein. You are consenting to receive healthcare services via telehealth technology as part of your Bloom360 membership.

2. What Is Telehealth

Telehealth is the delivery of healthcare services using electronic communications, information technology, and telecommunications technology when you and your healthcare provider are not in the same physical location. Bloom360 is a preventive telehealth clinic — not a one-off urgent visit service. Our model is built on ongoing, relationship-based care delivered entirely through telehealth, including synchronous video visits and asynchronous messaging with your care team.

Telehealth may involve the use of secure video conferencing, secure messaging, electronic health records, remote monitoring, and other digital health tools to deliver care, communicate health information, and coordinate services.

3. Your Bloom360 Care Team

When you join Bloom360, you are assigned a dedicated care team that may include:

• Primary Care Provider (PCP): A licensed physician or advanced practice provider who oversees your preventive care, manages chronic conditions, orders tests and prescriptions, and coordinates your overall health plan.
• Registered Dietitian: A licensed nutrition professional who provides personalized nutritional counseling, meal planning support, and guidance for managing dietary needs related to your health goals or conditions.
• Physical Therapist: A licensed physical therapist who provides movement assessments, exercise prescriptions, injury prevention guidance, and musculoskeletal care via telehealth.
• Reproductive Health Specialist: A provider with specialized training in reproductive and sexual health who can address contraception, fertility awareness, menstrual health, and related concerns.
• Care Coordinator: A team member who helps coordinate referrals, manage appointments, facilitate communication between your care team, and assist with navigating the healthcare system.

4. Potential Benefits

Telehealth services may offer the following benefits:

• Improved Access: Ability to receive care from your home or any private location without travel.
• Scheduling Flexibility: More convenient appointment times that fit your schedule.
• Reduced Costs: Elimination of travel time and associated expenses, with transparent flat-rate pricing.
• Continuity of Care: Ongoing relationship with a dedicated care team that knows your history.
• Ongoing Support: Access to asynchronous messaging with your care team between scheduled visits for questions, follow-ups, and health coaching.

5. Risks and Limitations

As with any healthcare service, telehealth has potential risks and limitations that you should understand:

5.1 Clinical Limitations

• Your provider cannot perform a hands-on physical examination, which may limit diagnostic capabilities.
• Certain conditions may require in-person evaluation, diagnostic testing, or specialist referral that cannot be provided through telehealth.
• Delays in evaluation or treatment may occur if your provider determines that telehealth is not appropriate for your situation.
• Your provider may not have access to your complete medical history from other providers, which could affect care decisions.

5.2 Technology Risks

• Poor internet connectivity, hardware malfunctions, or software issues may interrupt or degrade the quality of your visit.
• Audio or video quality may be insufficient for clinical assessment in some cases.
• Technical difficulties may cause delays or require rescheduling your appointment.

5.3 Information Risks

• Despite our security measures, electronic communication carries inherent risks, including the possibility of unauthorized interception of your health information.
• We use encryption and other safeguards to minimize these risks, but no system can guarantee absolute security.

6. Scope of Care

Bloom360 provides preventive primary care services via telehealth. Our scope of care includes but is not limited to:

• Wellness visits and annual health assessments
• Chronic disease management (e.g., hypertension, diabetes, asthma)
• Health coaching and lifestyle modification support
• Nutritional counseling and dietary guidance
• Physical therapy assessments and exercise prescriptions
• Reproductive and sexual health services
• Prescription management (non-controlled substances only)
• Lab and diagnostic test ordering
• Referrals and care coordination

Bloom360 does NOT:

• Prescribe controlled substances (see our Controlled Substances Policy)
• Provide emergency medical services
• Provide specialist care (e.g., cardiology, oncology, surgery)
• Provide mental health crisis intervention
• Replace the need for in-person care when clinically indicated

7. Privacy and Data Security

Bloom360 is committed to protecting your health information. Our telehealth platform complies with the Health Insurance Portability and Accountability Act (HIPAA) and applicable state privacy laws. We implement the following safeguards:

• Encryption: All data transmitted during telehealth visits is encrypted in transit and at rest.
• Access Controls: Only authorized members of your care team can access your health information.
• Business Associate Agreements: All third-party vendors who handle your PHI are required to sign HIPAA-compliant Business Associate Agreements.
• Security Assessments: We conduct regular security assessments and audits of our systems.

For more information, please review our Privacy Policy and Notice of Privacy Practices.

8. Access to Health Records

You have the right to access your health records maintained by Bloom360. You may view your records through your Bloom360 account or request copies by contacting us at care@bloom360.com. We will provide your records in a timely manner in accordance with applicable law.

9. Your Rights as a Patient

As a Bloom360 patient, you have the right to:

• Receive information about your diagnosis, treatment options, and prognosis in terms you can understand.
• Participate in decisions about your care, including the right to refuse or withdraw consent for treatment at any time.
• Request a second opinion or referral to another provider.
• Access your health records and request amendments to inaccurate information.
• Privacy and confidentiality of your health information.
• Be treated with dignity, respect, and without discrimination.
• File a complaint or grievance without fear of retaliation.
• Receive a clear explanation of fees and charges.

10. Your Responsibilities as a Member

As a Bloom360 member, you agree to:

• Provide accurate and complete health information to your care team, including your current medications, allergies, health history, and any changes in your condition.
• Follow the treatment plan agreed upon with your care team, or communicate with your team if you are unable to do so.
• Ensure you are in a private, secure, and appropriate location during telehealth visits.
• Use a device with a functioning camera, microphone, and stable internet connection for video visits.
• Notify your care team promptly of any adverse reactions, unexpected symptoms, or changes in your health status.
• Treat all Bloom360 staff and providers with respect and courtesy.
• Keep your account and contact information up to date.
• Not record telehealth visits without the prior consent of all participants.

11. Emergencies and After-Hours

Bloom360 does not provide emergency medical services. If you are experiencing a medical emergency, please take the following steps:

• Call 911 or go to the nearest emergency room immediately for life-threatening situations.
• Call 988 (Suicide & Crisis Lifeline) if you are experiencing a mental health crisis, suicidal thoughts, or emotional distress.
• Contact your local urgent care center for non-life-threatening conditions that require immediate attention outside of Bloom360's scope.

Do not rely on Bloom360 for urgent or emergency care. Our Services are designed for scheduled and asynchronous preventive care, not real-time emergency response.

12. Minors

Bloom360 provides services to individuals aged 16 and older. For members between the ages of 16 and 17, the following applies:

• A parent or legal guardian must provide consent for the minor to receive telehealth services and must co-sign this Consent form.
• A parent or legal guardian must create or authorize the creation of the minor's account.
• Certain health information may be shared with the parent or legal guardian as required or permitted by law, subject to applicable minor consent and confidentiality laws.

13. State-Specific Requirements

Telehealth services are subject to state-specific laws and regulations. Depending on your state of residence or the state in which you are located at the time of your visit, additional consent requirements, disclosures, or limitations may apply. We will inform you of any state-specific requirements that are applicable to your care. By accepting this Consent, you acknowledge that you are physically located in a state where Bloom360 providers are licensed to practice at the time of each telehealth encounter.

14. Withdrawing Consent and Policy Changes

You have the right to withdraw your consent for telehealth services at any time by notifying us in writing at care@bloom360.com. Withdrawing consent will not affect any services provided prior to the withdrawal. If you withdraw consent, you may not be able to continue receiving services through Bloom360, as our care model is delivered exclusively via telehealth.

We may update this Consent from time to time. When we make material changes, we will provide notice through our platform or by email. Your continued use of our Services after the effective date of any changes constitutes your acceptance of the updated Consent.

15. Questions

If you have any questions about this Telehealth Informed Consent or about our telehealth services, please contact us:

• Email: care@bloom360.com
• Mail: Bloom360, Inc., 4444 2nd Ave Ste 30674, Detroit, MI 48201