Telehealth Consent — Michigan

This Telehealth Consent explains how clinical services are delivered through the Novus MD platform and what you are agreeing to when you receive care via telehealth. You must sign this consent before your first consultation. Your signature is required — this is not a passive checkbox.

1. What Is Telehealth

Telehealth is the delivery of clinical services using electronic communications technology, including synchronous audio-visual consultations and asynchronous secure messaging. Your consultations will be conducted via the Elation Health telehealth platform.

2. How Your Care Is Delivered

All clinical services are provided by licensed clinicians employed or contracted by Pelerin Medical Services, PLLC (the "Practice"). The Practice operates independently of Novus MD LLC, which provides only the technology platform and administrative services.

3. What You Are Consenting To

By signing this consent, you acknowledge and agree to the following:

• Telehealth delivery — your clinical services will be delivered via audio-visual technology. Your clinician will not conduct an in-person physical examination as part of your standard care.
• Limitations of telehealth — telehealth has inherent limitations compared to in-person care, including your clinician's ability to observe physical signs and respond to emergencies in real time. Your clinician will use clinical judgment to determine whether telehealth is appropriate for your situation.
• Electronic transmission of health information — your health information will be transmitted and stored electronically, with encrypted transmission and secure storage.
• Laboratory requirements — prior to initiating any hormone therapy, you will be required to complete baseline laboratory testing at a local draw site.
• Prescription decisions — purchasing a Novus MD membership does not guarantee a prescription. All prescribing decisions are made exclusively by your licensed clinician based on clinical evaluation and laboratory results.
• Medication delivery — if a prescription is issued, your medication will be compounded and shipped directly to your home. You will sign a Power of Attorney authorizing direct home delivery before your first controlled-substance prescription is filled.
• Right to in-person care — you retain the right to seek in-person medical services at any time. Telehealth is not a substitute for emergency care. If you experience a medical emergency, call 911 or go to your nearest emergency room.
• Right to withdraw consent — you may withdraw this consent at any time by notifying the Practice in writing at privacy@novusmd.com. Withdrawing consent ends your ability to receive telehealth services through the Practice but does not affect your right to seek care elsewhere.

4. Technical Requirements and Failures

You need a device with a working camera and microphone, a stable internet connection, and access to the Elation Health patient portal. If a technical failure interrupts a consultation, your clinician will attempt to reconnect; if reconnection isn't possible, you'll be contacted to reschedule. In a clinically urgent situation, call 911 or seek in-person care immediately.

5. Licensed State

This consent applies to care delivered to patients located in Michigan. Dr. Tom Egan is licensed to practice in Michigan. Services are not available to residents of any state not listed at novusmd.com/state-availability.

6. DEA Telehealth Prescribing Authorization

The Practice's current prescribing model operates under DEA telehealth flexibilities in effect through December 31, 2026, permitting prescribing of Schedule III controlled substances (including testosterone) via telehealth without a prior in-person examination. If these flexibilities are not extended, the Practice may require an in-person evaluation before prescribing. You will be notified of any change before it affects your care.

7. Privacy

Your health information is protected under HIPAA and governed by the Practice's Notice of Privacy Practices. Please review it before signing this consent.

8. Contact