Telehealth Informed Consent

Your treating healthcare provider at Lux Health, LLC d/b/a Goza may be Pedro Alvarez, PA-C, a Physician Assistant licensed by the Florida Department of Health, or Ivis Alvarez, ARNP, an Advanced Registered Nurse Practitioner licensed by the Florida Department of Health (license numbers available upon request at support@goza.health). The practice operates under the supervision of its Medical Director, Adam E. Leisy, MD, a physician licensed in the State of Florida. All telehealth services are provided in accordance with Florida Statutes Section 456.47 and the applicable rules of the Florida Board of Medicine (Rule 64B8) and the Florida Board of Nursing.

Standard of Care. Telehealth services provided by Goza are held to the same standard of care as services provided in an in-person setting. Your provider will exercise the same professional judgment, diligence, and expertise as would be applied during an in-person visit, consistent with Florida law and the standards of the relevant professional boards.

Right to In-Person Care. You have the right to request an in-person evaluation instead of, or in addition to, a telehealth visit. If you prefer an in-person visit or if your provider determines your condition is not appropriate for telehealth, you will be referred to an appropriate in-person provider or facility.

Lux Health, LLC, d/b/a Goza ("Company," "we," "us," or "our") provides telehealth and healthcare-related services through electronic communications, information technology, and other means. Telehealth involves the delivery of healthcare services when the healthcare provider and patient are not in the same physical location.

Telehealth includes both:

• Synchronous Services: Real-time video consultations, phone consultations, and live chat communications between you and a healthcare provider
• Asynchronous Services: Questionnaire-based intake, secure messaging, store-and-forward communications, and electronic health assessments where communication between you and the provider does not occur in real time

Telehealth services may include, but are not limited to: remote consultations via secure video platforms, phone consultations, electronic messaging, online patient intake forms, and prescription management (where applicable).

Telehealth services offer potential benefits, including but not limited to:

• Convenience in accessing healthcare providers from your home or other location
• Protection against the transmission of communicable illnesses
• Improvements to the quality of care when your clinician can consult with other providers as needed
• Reduced travel time and costs associated with in-person visits
• Improved access to medical care for patients in remote or underserved areas
• More efficient care coordination between healthcare providers

You understand that telehealth services involve certain risks and limitations, including but not limited to:

• Technological risks, including disruptions to call or video connection and other technical difficulties
• The unavoidable risk of unauthorized access when sending or receiving protected health information electronically
• Certain conditions and treatments may not be suitable for telehealth and may require an in-person visit
• The healthcare provider may not have access to all of your medical records during the telehealth visit
• Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment or technology
• In rare cases, information transmitted may not be sufficient to allow for appropriate medical decision-making
• A lack of access to your complete medical record could result in adverse drug interactions, allergic reactions, or other complications

By consenting to telehealth services, you agree to the following responsibilities:

• You must be physically located in the State of Florida at the time of the telehealth visit or service
• You must conduct the visit in a private space where others cannot overhear or see private information on the screen
• You are solely responsible for ensuring privacy and confidentiality on your end
• You may not record (audio or video) any telehealth consultation. The Company does not routinely record telehealth consultations; if recording or AI-assisted documentation tools are utilized by the Provider, you will be separately notified and your consent will be obtained
• You must not drive during the appointment
• You must be appropriately dressed as if visiting the office
• You must turn off all other electronic devices and social media during the appointment
• You must be connected to the patient portal and ready for your visit at least ten (10) minutes prior to the scheduled time
• If you use the internet for telehealth, you should use a network that is private and secure
• You are responsible for providing truthful, accurate, and complete health information to your healthcare provider, including your current medications, allergies, medical history, and symptoms
• Patient Identity Verification: You represent that you are the person named in your account and that all identifying information you provide is accurate. The Company may verify your identity through government-issued photo identification, date of birth, multi-factor authentication, or live video confirmation at any time. Misrepresentation of identity is prohibited and may result in termination of services, forfeiture of fees, and referral to law enforcement.

All clinical decisions, including the decision to prescribe or not prescribe medication, are made solely by the treating healthcare provider in the exercise of their independent professional judgment and in accordance with applicable standards of care, laws, and regulations.

You further acknowledge that the healthcare provider may determine that telehealth is not appropriate for your condition and may decline to provide treatment via telehealth, in which case you may be advised to seek in-person care. No refund shall be due solely because a prescription was not issued or a desired treatment was not provided.

You have the right to withdraw from or discontinue treatment at any time without penalty. You may refuse any recommended treatment, medication, or procedure. If you choose to withdraw from treatment, you agree to notify the Company in writing. Withdrawal from treatment does not affect your obligation to pay for Services already rendered. The Company and its healthcare providers shall not be liable for any adverse health consequences resulting from your decision to withdraw from or refuse recommended treatment.

You or the healthcare provider may discontinue the telehealth consultation at any time if either party determines that technical difficulties are too disruptive to continue or that the visit is not suitable for telehealth. In such cases, the provider may ask you to schedule an in-person visit.

In the event a telehealth consultation cannot be completed due to a Provider-side technical failure or the Provider's inability to render care, a refund or rescheduling will be offered at the Company's discretion. Patient-side technical failures (including inadequate internet connectivity, device malfunction, or failure to connect to the patient portal on time) do not entitle the patient to a refund. See the Patient Financial Consent Form for complete refund and fee policies.

The Company is not a substitute for your primary care physician and does not replace the relationship between you and your existing healthcare providers.

All telehealth consultations are conducted through secure, HIPAA-compliant platforms. Your Protected Health Information (PHI) will be handled in accordance with our Notice of Privacy Practices and applicable federal and state laws. While we implement robust security measures, there is an unavoidable risk of unauthorized access when transmitting information electronically.

The Company's telehealth Services are currently available only to patients who are physically located in states where our healthcare providers are licensed to practice at the time of the telehealth visit or service. As of the effective date of this Consent, Services are available to patients physically located in the State of Florida. The Company may expand or restrict the geographic availability of its Services at any time without notice. It is your responsibility to verify that Services are available in your location before scheduling an appointment.

This Telehealth Informed Consent is in addition to, and does not replace, the Company's Terms and Conditions, Privacy Policy, Notice of Privacy Practices, Consumer Health Data Privacy Policy, and Patient Financial Consent Form. In the event of any conflict between this Consent and the Terms and Conditions, this Consent shall control with respect to telehealth-related matters.

You must be at least eighteen (18) years of age to receive telehealth services from Goza. The Company does not currently provide pediatric care or treat minors. If you are a parent or legal guardian seeking care on behalf of a minor, the Services are not available for that purpose. By signing this Consent, you represent and warrant that you are 18 years of age or older.

As a patient of Goza, you have the right to:

• Be treated with dignity, respect, and cultural sensitivity
• Receive information about your condition, treatment options, and risks/benefits in a manner you can understand
• Participate in decisions about your care, including the right to refuse treatment
• Access your medical records in accordance with Florida Statute 456.057
• Receive care that meets the applicable standard of care, whether provided in person or via telehealth

Filing a Complaint. If you have a concern about your care, we encourage you to contact us first at support@goza.health or (305) 306-1387. You also have the right to file a complaint with the following regulatory bodies:

• Florida Department of Health, Consumer Services Unit — Telephone: 1-888-419-3456; Website: flhealthsource.gov; Online: https://www.flhealthsource.gov/consumer-services
• Florida Board of Medicine — https://flboardofmedicine.gov (for complaints involving the supervising physician / Medical Director)
• Florida Board of Nursing / Council on Physician Assistants — https://floridaspa.gov (for complaints about PA or ARNP providers)
• U.S. Department of Health and Human Services, Office for Civil Rights (for HIPAA complaints) — https://www.hhs.gov/ocr/

Filing a complaint will not affect your ability to receive future services from the Company, and the Company will not retaliate against you for exercising this right.

Goza provides services in English and Spanish. If you require an interpreter in another language, auxiliary aids, or reasonable accommodations for a disability to effectively communicate with your provider, please contact us at support@goza.health or (305) 306-1387 prior to your appointment. The Company complies with Section 1557 of the Affordable Care Act and the Americans with Disabilities Act (ADA), which prohibit discrimination on the basis of race, color, national origin, sex, age, or disability.

By typing your full legal name and submitting the intake form, you intend to electronically sign this Telehealth Informed Consent. You agree that your electronic signature has the same legal force and effect as a handwritten signature under the federal Electronic Signatures in Global and National Commerce Act (15 U.S.C. Section 7001 et seq., the "E-SIGN Act"), the Uniform Electronic Transactions Act as adopted by Florida (Florida Statutes Chapter 668, Part I), and applicable healthcare laws permitting electronic informed consent.

At the time you sign, the Company records the following to establish the authenticity of your signature: (a) the date and time of your signature; (b) your IP address; (c) your device/browser information (user agent); (d) the exact version of this Consent you agreed to; and (e) a tamper-evident cryptographic hash linking your consent record to all prior consent records. This record is retained as an independent audit log in addition to your clinical chart.

Right to Paper Copy. You have the right to receive a paper copy of this Consent at no charge by contacting support@goza.health. You may withdraw consent to do business electronically at any time by contacting us, provided that such withdrawal will preclude you from continuing to use our telehealth Services, which are provided exclusively via electronic means.

Hardware and Software Requirements. To access and retain electronic records, you need: (i) a computer or mobile device with internet access; (ii) a current web browser (Chrome, Safari, Firefox, or Edge, most recent two versions); (iii) an active email account; and (iv) software capable of viewing PDF documents (such as Adobe Acrobat Reader).