Virtual care & electronic communication consent

Consent for Use of Virtual Care Tools and Electronic Communications

I confirm that I have reviewed and understand the risks, limitations, conditions of use, and instructions for the virtual care and electronic communication services provided by HairGain®-Clinic. This includes, but is not limited to, the HairGain®-Clinic website, online medical intake forms, patient portal, email communications, text messages, telephone calls, video consultations, prescription-related communications, and other forms of electronic communication collectively referred to as the “HairGain®-Clinic Platform.”

The HairGain®-Clinic Platform is intended to support virtual health consultations related to hair loss, hair thinning, alopecia, and related scalp or hair-health concerns. I understand that information collected may include my personal information and personal health information, including but not limited to my medical history, current medications, allergies, symptoms, hair-loss history, photographs of my scalp or hair, diagnoses, treatment recommendations, prescriptions, pharmacy information, payment information, and follow-up care details.

I acknowledge and accept the risks associated with using the HairGain®-Clinic Platform and electronic communications with HairGain®-Clinic physicians, nurse practitioners, pharmacists, pharmacy staff, clinic staff, and other authorized healthcare professionals involved in my care collectively referred to as “Authorized Healthcare Professionals.”

I agree to follow the conditions and instructions described in this notice and any additional instructions provided by the Authorized Healthcare Professionals involved in my consultation, treatment, prescription, dispensing, or follow-up care.

I understand that while reasonable efforts are made to protect the privacy and security of my information, electronic communications may not be completely secure. I understand that if I choose to communicate by email, text message, or other electronic means, communications may be sent or received in encrypted or unencrypted form. Unencrypted communication carries additional privacy and security risks, including the possibility of being intercepted, misdirected, accessed, altered, or disclosed.

I understand that either I or the Authorized Healthcare Professional may withdraw the option for electronic communication at any time by closing my account, ending the consultation, or providing written notice.

All my questions have been addressed. If I have further questions or concerns regarding the handling or storage of my personal information by HairGain®-Clinic, I may contact HairGain®-Clinic at:

help@hairgainmd.com

I acknowledge that if I receive a prescription through HairGain®-Clinic, I may choose the pharmacy where my prescription is filled. If I choose to use a pharmacy affiliated with or recommended by HairGain®-Clinic, my prescription may be dispensed by a licensed pharmacy, including a compounding pharmacy where appropriate. I understand that I am not obligated to use a specific pharmacy and may request that my prescription be sent to a pharmacy of my choice, where permitted.

Risks Associated with Virtual Care Tools and Electronic Communication

Although HairGain®-Clinic and its Authorized Healthcare Professionals will make reasonable efforts to protect the security and confidentiality of information transmitted through the HairGain®-Clinic Platform, complete security cannot be guaranteed.

I understand and accept the following risks:

• Sensitive personal health information communicated electronically may be disclosed to unauthorized third parties.
• Complete security of information transmitted through the HairGain®-Clinic Platform cannot be guaranteed.
• Employers, internet service providers, email providers, device owners, or other third-party services may have the ability or legal right to monitor, access, store, or retain electronic communications.
• Electronic communications may introduce malware, viruses, or other harmful software to devices, systems, or networks.
• Backup copies of electronic communications may continue to exist even after deletion.
• Electronic communications may be disclosed if required by law, regulation, court order, professional obligations, or other legal process.
• Email, text messages, and other electronic communications may be misdirected, intercepted, altered, delayed, spoofed, or falsely represented.
• Technical issues, internet interruptions, software errors, platform outages, or device problems may interfere with access to virtual care services.

Conditions for Using the HairGain®-Clinic Platform

The HairGain®-Clinic Platform is not suitable for emergencies or urgent medical matters.

If I believe I am experiencing a medical emergency, a severe allergic reaction, severe pain, rapidly worsening symptoms, or any urgent health concern, I should call 911, go to the nearest emergency department, or seek immediate in-person medical care.

Electronic communication is not a substitute for in-person medical care, a physical examination, diagnostic testing, or emergency services. I understand that virtual care may have limitations, especially because the Authorized Healthcare Professional may not be able to physically examine my scalp, hair, skin, or overall health condition.

Authorized Healthcare Professionals may rely on the accuracy and completeness of the information I provide, including medical history, medications, allergies, prior diagnoses, family history, symptoms, photographs, and treatment goals. I understand that inaccurate, incomplete, or misleading information may affect the quality, safety, or appropriateness of care.

If I do not receive a timely response to an electronic communication, it is my responsibility to follow up and confirm that the communication was received.

Electronic communications may become part of my medical record and may be accessed by authorized personnel involved in my care, treatment, dispensing, billing, administration, or follow-up.

Authorized Healthcare Professionals may forward communications to clinic staff, pharmacy staff, administrative staff, or other professionals involved in my care, but will not intentionally share my personal health information with unauthorized third parties without my consent unless required or permitted by law.

I should notify HairGain®-Clinic of any information that I do not wish to be communicated electronically.

Some areas of the HairGain®-Clinic Platform may be used for educational, administrative, intake, payment, marketing, or informational purposes only and may not constitute medical advice, diagnosis, treatment, or a therapeutic relationship.

Technical problems with my device, internet connection, software, email account, or third-party services are not the responsibility of HairGain®-Clinic or its Authorized Healthcare Professionals.

HairGain®-Clinic and its Authorized Healthcare Professionals may decline to provide care, discontinue a consultation, refuse to issue a prescription, recommend in-person assessment, or refer me to another healthcare provider if virtual care is not appropriate, safe, or sufficient for my situation.

Instructions for Communicating Through the HairGain®-Clinic Platform

I agree to use the HairGain®-Clinic Platform responsibly and to provide accurate, complete, and current information.

When using virtual care or electronic communication, I should:

• Use a private and secure device whenever possible.
• Avoid using employer-owned, shared, public, or third-party computers or devices when communicating personal health information.
• Participate in virtual consultations from a private and secure environment.
• Ensure that no unauthorized person can view, overhear, record, or access my consultation or communications without my consent.
• Obtain consent before recording any telephone, video, or virtual interaction.
• Notify HairGain®-Clinic promptly of any changes to my contact information, medical history, medications, allergies, pharmacy preference, or relevant health information.
• Use clear subject lines when communicating by email and include my full name and relevant identifying information.
• Review all electronic communications for accuracy and clarity before sending.
• Confirm receipt of important communications when appropriate.
• Protect the confidentiality of my account credentials, email account, phone, device, and any documents or communications received from HairGain®-Clinic.

For urgent matters, worsening symptoms, severe reactions, or emergency concerns, I should not rely on the HairGain®-Clinic Platform and should seek immediate medical attention through appropriate emergency or in-person care channels.

Scope of Healthcare Services

HairGain®-Clinic provides virtual healthcare services focused on hair loss, hair thinning, alopecia, and related hair-health concerns. This may include medical intake, review of health history, assessment of hair-loss concerns, review of patient-submitted photographs where appropriate, treatment recommendations, prescription consideration, pharmacy coordination, and follow-up support.

HairGain®-Clinic services may include assessment and treatment options for concerns such as androgenetic alopecia, male pattern hair loss, female pattern hair loss, hair thinning, and other hair-loss concerns where virtual care is appropriate. Services may vary depending on the province or territory, applicable laws, professional standards, patient eligibility, and the clinical judgment of the Authorized Healthcare Professional.

I understand that HairGain®-Clinic may not be appropriate for all types of hair loss or scalp conditions. Certain symptoms or medical concerns may require in-person examination, laboratory testing, specialist referral, urgent care, or emergency assessment.

I understand that Authorized Healthcare Professionals may not have access to my complete medical record and may not be able to perform a physical examination. They rely on the information I provide and any photographs, documents, or test results I submit.

I understand that treatment outcomes cannot be guaranteed. Hair-loss treatment results may vary between individuals and may depend on factors such as diagnosis, age, genetics, hormonal factors, medical conditions, medication use, adherence to treatment, duration of treatment, and other individual factors.

I understand that a prescription is not guaranteed. A prescription will only be issued if the Authorized Healthcare Professional determines that it is clinically appropriate, safe, and permitted.

I agree to carefully review all medication instructions, warnings, contraindications, and pharmacy counselling information provided to me. I agree to ask a licensed healthcare professional if I have questions about how to use a prescribed medication, potential side effects, interactions, pregnancy or breastfeeding considerations, or whether treatment is appropriate for me.

Pharmacy Services and Prescription Fulfilment Consent

If a prescription is issued through HairGain®-Clinic, I understand that the prescription may be sent to a licensed pharmacy for dispensing. I may choose to use a pharmacy affiliated with or recommended by HairGain®-Clinic, or I may request that my prescription be sent to another pharmacy of my choice, where permitted.

Pharmacy services may include prescription review, compounding where applicable, dispensing, medication counselling, refill coordination, insurance or payment support, shipping coordination, and follow-up communication.

I understand that pharmacy communications may occur by phone, email, text message, online forms, or other electronic communication methods. These communications may include prescription status, payment information, refill reminders, shipping updates, medication instructions, counselling, and requests for additional information.

I understand that despite reasonable privacy and security safeguards, pharmacy-related electronic communications may involve encrypted or unencrypted communication and may carry privacy and security risks.

I understand that pharmacy services are not suitable for emergencies. If I experience a serious side effect, severe allergic reaction, or urgent medical concern, I should seek immediate medical care.

I understand that any pharmacy involved in my care may rely on accurate information provided by me, HairGain®-Clinic, and the prescribing Authorized Healthcare Professional.

I understand that pharmacy services may be declined or discontinued based on professional judgment, regulatory requirements, safety concerns, incomplete information, medication availability, or other appropriate reasons.

Definitions

Authorized Healthcare Professionals means licensed physicians, nurse practitioners, pharmacists, pharmacy technicians, and other regulated healthcare professionals involved in providing care, treatment, prescribing, dispensing, counselling, or follow-up services through or in connection with HairGain®-Clinic.

Electronic Communications means communications sent, received, or stored through electronic or telecommunication methods, including email, text message, telephone, video conferencing, online forms, patient portals, images, documents, and other digital communications, whether encrypted or unencrypted.

HairGain®-Clinic Platform means the website, software, systems, tools, forms, portals, email communications, text communications, telephone communications, video consultations, and other technologies used by HairGain®-Clinic to provide or support virtual healthcare services.

Personal Information means information about an identifiable individual, including personal health information, as defined by applicable privacy laws.

Pharmacy Services means professional services provided by a licensed pharmacy, pharmacist, pharmacy technician, or pharmacy staff, including prescription review, dispensing, compounding, counselling, refill management, shipping coordination, payment processing, and related support.

User means an individual who registers with, accesses, communicates with, or receives services through HairGain®-Clinic.

Virtual Care means healthcare services provided remotely using electronic communication tools rather than through an in-person visit.

Virtual Care Tools means technologies that enable remote communication, assessment, consultation, documentation, prescribing, dispensing support, or follow-up care, including telephone, email, text message, video conferencing, online forms, and patient portals.

Contact

For questions, concerns, privacy inquiries, or medical record access requests, please contact HairGain®-Clinic at:

help@hairgainmd.com