Wheel Provider Group Telehealth Informed Consent

Last Updated: February 2026

IF YOU HAVE A MEDICAL EMERGENCY, IMMEDIATELY CALL YOUR PRIMARY CARE PROVIDER OR DIAL 911.

This is a legal and binding document between you and Wheel Medical, P.A., a Florida professional association, on behalf of itself and its affiliated professional entities (collectively, “Wheel Provider Group,” “We,” “Our”, or “Us”). Read it carefully before clicking “I accept”.

By clicking “I accept”, you hereby consent to receive health care services from licensed health care providers contracted with Wheel Provider Group (“Providers”) who are located at sites remote from you to provide consultative services to you. The receipt of health care services from a Provider (the “Services”) is a type of “telemedicine” or “telehealth” service.

Wheel Health, Inc. does not provide the Services; provides certain technology and support services to Wheel Provider Group and Providers and may receive, create, maintain, or transmit certain information on behalf of Wheel Provider Group in accordance with applicable law and contractual safeguards.

Description of Services

Healthcare providers contracted with Wheel-affiliated professional entities (“Providers”) provide consultations through the use of synchronous and asynchronous telecommunication technologies depending on your state’s legal and regulatory requirements. The Wheel-affiliated Provider conducting the consult determines the scope of services for diagnosis, treatment, and care, including prescribing appropriate medication or devices. If you have any clinical questions in connection with your Telehealth Consult, please contact Wheel at the contact information below and you will be connected or directed to a member of the Wheel clinical team.

Providers may include behavioral health or primary care practitioners, nurse practitioners, physician’s assistants, specialists, and/or subspecialists. The name, credentials, and specialty or subspeciality of your Provider will be disclosed to you before, during, or after the Services are provided. In some cases, telemedicine visits may not be the most appropriate way for you to seek medical care and treatment. For example, certain medical conditions may require an in-person procedure, more urgent attention, or a health care provider other than your health care provider using the Services.

• We may ask you a series of initial questions to help you determine whether a telemedicine visit is appropriate for you. Based on your responses to these questions, we may determine that a telemedicine visit may not be appropriate for the particular issue for which you are seeking a telemedicine visit or for other reasons related to your health status. In such a case: (i) you will receive an alert notifying you that you will be unable to use the Services for the particular issue you submitted; (ii) your request for a telemedicine visit will not be submitted to your Provider; (iii) your Provider will not receive any of the information that you submitted; and (iv) you will need to seek any needed care in another way.
  Your Provider may, following submission of a telemedicine visit request, determine that your diagnosis or treatment requires an in-person office visit or is otherwise not appropriately addressed through use of the Services. In such a case, your
• Provider may notify you that you will be unable to use the Services for the particular issue you submitted and provide additional information regarding next steps. Your Provider is solely responsible for providing you any such notification, whether through the Services or by some other means.
• We will use store-and-forward technology, audio-only consultations, and/or audio-video consultations to provide the Services. To ensure privacy and confidentiality of the Services, we use industry standard security measures. The Services may, but not necessarily will, result in a new prescription, refilling an existing prescription, patient education, non-prescriptive recommendations, or a recommendation to seek follow-up care in-person or through a different provider.
• A Provider may also perform Clinician Oversight for laboratory tests provided by third-party healthcare providers. Clinician Oversight involves ordering tests when appropriate, providing Patient Outreach when appropriate (defined below), and reviewing and releasing test results. Wheel does not provide laboratory tests and is not responsible for the provision of laboratory tests or other services provided by third parties or through third-party websites. If you receive a laboratory test result with a value that is outside the normal range to a degree that may constitute an immediate health risk to you or require immediate action on the part of the ordering Provider (“Critical Result”), a Provider will attempt to contact you via phone directly and if unsuccessfully, will send a link to join a video visit to notify you and discuss the Critical Result. If you receive a laboratory result that is below the established norms for a particular test, but not as urgent as a Critical Result (“Abnormal Result”), the Provider will review for symptoms, educate you on the test results, and make recommendations for follow-up treatment (“Patient Outreach”).
• The Wheel-affiliated Provider will neither initiate treatment nor prescribe any medication or device but rather will direct you to follow up with your regular healthcare practitioner or primary care physician. You are solely responsible for forwarding any test results to your primary care provider and for initiating follow up with such provider for care, diagnosis, or medical treatments. Wheel will not forward your results to your provider; however you will be provided with results that you can download and bring to your provider. If you have any clinical questions in connection with the Clinician Oversight, please contact Wheel at the contact information below and you will be connected or directed to a member of the Wheel clinical team.
• Wheel Provider Group will have no responsibility or liability for your Provider’s delay or failure to respond to a telemedicine visit request, to notify you that your telemedicine visit cannot be completed, or to provide you with next steps or follow-up information, or for any care, medical advice or treatment provided by your Provider.

Information regarding payment for Clinician Oversight and Telehealth Services is provided on the websites of our healthcare partners.

Use of Artificial Intelligence

As part of a patient consultation, our Providers may use an artificial intelligence program to assist in generating medical documentation and supporting certain clinical workflows. The artificial intelligence program records, captures and transcribes details from your consultation to create comprehensive and accurate clinical notes and to update your health records, allowing your Provider to focus entirely on your care. You understand that this serves as your informed consent that your visit will be recorded and transcribed. However, at the beginning of your telehealth visit you may ask that your Provider disables the use of this tool. If your Provider disables the tool at your request, your visit may still be documented through traditional methods (e.g., manual note-taking) in the Provider’s clinical record. You understand that the artificial intelligence program does not make clinical decisions or provide medical advice. We ensure that appropriate agreements are in place with such services before making any of your data available to them.

Provider Credentialing & Quality Assurance

Wheel Provider Group maintains credentialing and quality assurance processes designed to promote patient safety and clinical quality.

Before providing Services, each Provider must complete a credentialing process that includes primary source verification of licensure and scope of practice, National Provider Identifier (NPI), relevant education and training, work history, and professional standing. We also review applicable professional liability history and screen for certain federal sanctions or exclusions through recognized government databases. Where applicable, prescribing authority (including controlled substance registration) is verified. Providers who do not hold required credentials may be restricted from prescribing certain medications or providing certain Services.

Providers are subject to periodic recredentialing and ongoing monitoring to confirm continued licensure, good standing, and compliance with applicable requirements. If a concern arises, a Provider may be subject to additional review, restrictions, suspension, or removal from providing Services through Wheel Provider Group.

Wheel Provider Group maintains quality assurance activities, which may include clinical documentation review, peer or case review, and follow-up education or corrective action when appropriate.

Controlled Substances

Providers comply with applicable federal and state laws governing prescribing practices, including telehealth-specific requirements. Certain medications may be classified as controlled substances under the laws of specific states. In those states, Providers review and comply with applicable state prescribing requirements, which may include review of state prescription monitoring program (PDMP) databases or other regulatory obligations before prescribing.

Providers may decline to prescribe any medication if it is not clinically appropriate, not permitted under applicable law, or inconsistent with Wheel Provider Group’s prescribing policies.

Treatment-Specific Consents

Benefits and Risks

Your use of the Services may have the following possible benefits:

• Making it easier and more efficient for you to seek medical care and treatment for the conditions treated by the applicable health care provider;
• Allowing you to seek medical care and treatment by your  Provider at times that are convenient for you; and
• Enabling you to communicate with your Provider without the necessity of an in-office appointment.
• As with any medical procedure, there are potential risks associated with the use of telemedicine or telehealth services, which may include, without limitation, the following:
  • The information transmitted to your Provider may not be sufficient (e.g., poor resolution of images) to allow your Provider to make an appropriate medical decision;
  • Your Provider’s inability to conduct certain tests or assess vital signs in-person may in some cases prevent the provider from providing a diagnosis or treatment or from identifying the need for emergency medical care or treatment for you;
  • Your Provider may not be able to provide medical treatment for your particular condition and you may be required to seek alternative health care or emergency care services;
  • Delays in medical evaluation/treatment or a failure to obtain needed treatment could occur due to unavailability of your Provider, deficiencies or failures of the technology or electronic equipment used, a transmission delay or failure, issues with the internet or other communications means, or for other reasons;
  • The electronic systems, public networks, or security protocols or safeguards used in the Services could fail, causing a breach of privacy of your medical or other information;
  • Your Provider’s diagnosis and treatment options, especially pertaining to certain prescriptions, may be limited;
  • Lack of access to your medical records or ability to perform an in-person examination, which could result in negative health outcomes (e.g., adverse drug interactions, allergic reactions).

By clicking “I accept”, you also represent and warrant the following:

• Your Provider has discussed the use of telemedicine services with you, including the benefits and risks of such use and the alternatives to the use of the Services, and you have provided consent to your Provider for the use of the Services.
• You understand that you have the right to access your medical information created during use of the Services or to have the medical information forwarded to a third-party or alternative provider. Wheel will not forward any personally identifiable information to third parties or other providers without your written consent. This does not limit disclosures that are permitted or required by law (for example, to another treating provider for treatment purposes, or as otherwise permitted under HIPAA).
• You understand Wheel may use third-party vendors to provide the Services.
• You understand that the use of the Services involves electronic communication of your personal medical information to your Providers who may be located in other areas, including outside of the state in which you reside, and that the electronic systems, public networks, or security protocols or safeguards used in the Services could fail, causing a breach of privacy of your medical or other information. You agree to hold Wheel harmless for any information lost due to technical failures to the extent permitted by applicable law.
• You understand that, despite the privacy risks associated with the Services, all federal and state laws, rules, and regulations regarding privacy and confidentiality will apply to the Services, including HIPAA.
• You understand that it is your duty to provide your Provider truthful, accurate, and complete information, including all relevant information regarding care that you may have received or may be receiving from other health care providers or outside of the Services. You also understand that if you are uncomfortable with receiving the Services or the method in which the Services are provided, you should inform your Provider.
• You understand that your Provider may determine that your condition is not suitable for diagnosis or treatment using the Services, or may fail to respond promptly or ever to your request for a telemedicine service, and that you may need to seek medical care and treatment from your Provider, a specialist, or other health care provider outside of the Services.
• You understand that in the event of an emergency or an adverse reaction to treatment, you should dial 911 to receive appropriate follow-up care. In the event of technology failure or your Provider determining you need see another provider or make an in-person appointment, he or she will provide you with next steps or follow-up information.
• You understand the risks and benefits of the Services and its use in the medical care and treatment provided to you by your Provider. You also understand that you may refuse or withdraw from care at any time, and that your refusal or withdrawal will not affect your ability to receive care in the future.
• You understand that failure to comply with the terms of this document may result in the termination of your ability to use the Services.
• No potential benefits from the use of the Services, care provided via the Services, or specific results can be guaranteed. Your condition may not be cured or improved, and in some cases, may get worse.
• In connection with providing the Services, Wheel Provider Group and Wheel Health, Inc. may collect, use, store, and disclose health information and other information about you as permitted by applicable law and as described in our Notice of Privacy Practice. As permitted by law, Wheel Provider Group and Wheel Health, Inc. may also create and use aggregated and de-identified information derived from information collected in connection with the Services. De-identified information is information that cannot reasonably be used to identify you and is no longer considered protected health information under HIPAA. Once information has been aggregated or de-identified in accordance with applicable law, it may be used for lawful business purposes, including but not limited to improving and operating the Services and related technology; analytics, quality improvement, benchmarking; product development, machine learning, and artificial intelligence initiatives; research and insights; and other commercial and operational purposes. We maintain reasonable safeguards designed to prevent re-identification of de-identified information, and we prohibit recipients from attempting to re-identify such information, as required by applicable law.

Additional Terms Associated with Remote Visits

All health professionals performing licensed clinical services on the Services hold the professional licenses issued by the professional licensing boards or agencies in the states where they practice. All physicians, psychologists, and nurse practitioners hold advanced degrees and have undergone postgraduate training. You can report a complaint relating to the care provided by a health care professional by contacting the professional licensing board in the state where the care was received. In a professional relationship, sexual intimacy is never appropriate and should be reported to the board or agency that licenses, registers, or certifies the licensee.

You can find the contact information for each of the state professional licensing boards governing medicine on the Federation of State Medical Boards website at https://www.fsmb.org/contact-a-state-medical-board/ and governing psychology on the Association of State and Provincial Psychology Boards website at https://asppb.net/contact-licensing-board/.

Additional State-Specific Consents

The following consents apply to patients accessing the Services for the purposes of participating in a telehealth consultation within the states listed below, as required by state law:

• California Patients: The Open Payments database is a federal tool used to search payments made by drug and device companies to physician and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.

For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.

• Treatment Records: I understand that If I live in one of the following states, my primary care provider or other treating physician may obtain a copy of my telehealth treatment records with my consent, and Wheel may securely send a copy of my telehealth treatment records to my primary care provider or other treating physician. If I need help sending my telehealth treatment records to my primary care provider I can contact support@wheel.com. If I would like Wheel to do so, I can contact support@wheel.com and provide information necessary for Wheel to securely send my records.

  • Alaska: I understand that my primary care provider may obtain a copy of my records of my telehealth encounter.

  • Connecticut: I understand that my primary care provider may obtain a copy of my records of my telehealth encounter.

  • Kansas: I understand that if I have a primary care provider or other treating physician, the person providing telemedicine services must send a report to such primary care or other treating physician of the treatment and services rendered to me during the telemedicine encounter within three days of me providing consent to the person providing telemedicine services to send such report.

  • New Hampshire: I understand that my primary care provider or treating provider may obtain a copy of my records of my telehealth encounter.

  • New Jersey: I understand I have the right to request a copy of my medical information, and I understand my medical information may be forwarded directly to my primary care provider or health care provider of record, or upon my request, to other health care providers.

  • Ohio: I understand that my primary care provider may obtain a copy of my records of my telehealth encounter.

  • South Carolina: I understand that my medical records may be distributed only with my consent and in accordance with applicable laws and regulations to other treating health care practitioners.

  • Texas: I understand that with my consent my medical records may be sent to my primary care physician within 72 hours after receiving Services.

• Formal Complaints:

  • Iowa: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

  • Idaho: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

  • Indiana: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

  • Kentucky: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

  • Maine: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

  • Oklahoma: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here; or, the Oklahoma Board of Osteopathic Examiners’ website, here.

  • Oregon: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

  • Rhode Island: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

  • Texas:

    • NOTICE CONCERNING COMPLAINTS - Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353, For more information, please visit our website at www.tmb.state.tx.us.

    • AVISO SOBRE LAS QUEJAS - Las quejas sobre médicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353, Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us.

  • Vermont: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here; Or, the Vermont Board of Osteopathic Examiners’ website, here.

Acknowledgement

By clicking “I accept”, you (a) further certify that you are the patient, or that you are duly authorized by the patient as the patient’s representative or legal guardian, (b) acknowledge and accept the risks identified above and the terms associated with the receipt of clinical services via the Services, and (c) give your informed consent to receive clinical services under the terms described herein.