Telehealth Informed Consent.

Telemedicine is the delivery of health care services through the use of electronic communications technology by a provider located at one site to a patient located at another site. It may include evaluation, diagnosis, treatment, consultation, transfer of medical data, patient education, and related activities.

QuickVisitMD uses asynchronous secure-message exchange as its primary modality. That means:

• Your information (intake answers, messages, photos) is submitted through a secure portal and reviewed by the physician within the response window you choose, around the clock.
• There is no live video visit or in-person examination, and the clinical evaluation itself is asynchronous. For patients physically located in West Virginia, state law (W. Va. Code §30-3-13a) requires a brief real-time identity verification — a short physician-conducted call to confirm who you are — before the encounter is completed. If this applies to you, the physician will call you at the phone number you provide during intake to verify your identity; your medical concern is still evaluated asynchronously through the secure portal.
• All communication happens through secure messaging, documented portal updates, or a brief physician-initiated identity-verification call when required by state law.

Care is delivered by Ankur Fadia, MD, licensed in Virginia (license 0101254294) and West Virginia (license 26205), and only to patients physically located in those two states at the time of the encounter.

• Virginia.The practice of medicine in Virginia is governed by Virginia Code §54.1-2900 et seq., including §54.1-2901 (practice of medicine generally) and §54.1-2915 (grounds for denial, suspension, or revocation of license). You may verify the physician's Virginia license and file complaints through the Virginia Board of Medicine at (804) 367-4600.
• West Virginia.Telehealth in West Virginia is governed by W. Va. Code §30-3-13a and the rules of the West Virginia Board of Medicine. West Virginia law requires a brief real-time interactive step with the patient. QuickVisitMD satisfies this with a short physician-conducted call to verify your identity — confirming who you are — before your encounter is completed; the clinical evaluation of your concern is performed asynchronously through the secure portal. If you are physically located in West Virginia at the time of your request, the physician will conduct this brief identity-verification call with you. By providing your phone number during intake, you consent to receive this call. You may verify the physician's West Virginia license and file complaints through the West Virginia Board of Medicine at (304) 558-2921.

• Convenience — no travel, no waiting room, no need to align schedules for a live visit.
• A written, time-stamped record of what you described and what the physician recommended.
• Time to describe symptoms thoroughly without the pressure of a live interview.
• Focused care for low-acuity concerns that fit an online model.

• No physical examination. Findings that require an in-person exam may be missed.
• No live discussion through messaging. The physician cannot ask questions in real time through the portal. (West Virginia encounters include a brief physician-conducted identity-verification call as described in Section 3.)
• Dependence on the accuracy of what you submit — incorrect or incomplete information may lead to an incorrect recommendation.
• Technology failures, outages, image quality issues, or delivery delays are possible.
• Diagnosis certainty is not guaranteed. The physician may recommend in-person care instead of an online treatment plan.
• Protected health information sent electronically always carries some residual risk, even with secure systems.

QuickVisitMD is a limited-scope service. The following are not providedthrough this practice, regardless of the patient's preference:

• Controlled substances of any kind (schedules II-V).
• Ongoing or long-term medication management for any condition outside the defined set of non-controlled conditions this practice has approved for continuing care. Continuing care is not available on request: the physician decides whether you are clinically eligible. Nothing is refilled merely because time has passed: you must complete the follow-up the physician requests and, for the conditions that need them, provide current laboratory results, and the physician must then decide that prescribing remains appropriate. Completing follow-up, or paying for a visit, does not guarantee a prescription. A review is a physician visit, not a guaranteed prescription.
• Disability paperwork, FMLA forms, long-term leave certifications, or insurance attending-physician statements.
• Chronic pain management.
• DMV, FAA, DOT, pre-employment, occupational, or other licensing / fitness-for-duty examinations.
• Medical cannabis certifications or recommendations.
• Imaging orders (X-ray, CT, MRI, ultrasound) or laboratory requisitions.
• Incretin-based weight-loss or diabetes medicines (including GLP-1/GIP medicines), controlled weight-loss stimulants (selected non-incretin, non-stimulant options are offered after doctor review through the separate Weight management visit).
• Wound care or wound management.
• Care of complex or multi-system illness, and any condition that requires an in-person examination, hands-on monitoring, specialist coordination, or testing this practice cannot arrange.
• A substitute for a primary care physician or for in-person care. Where continuing care is provided, it is limited to the specific condition and medication the physician has agreed to manage. It is not general primary care, preventive care, or care coordination, and it does not cover your other conditions. You are encouraged to have a local clinician who knows your full history. This scope limit bounds the service; it does not prevent the physician from recommending in-person care, requesting records, communicating with another clinician with your authorization, or taking any other step the physician judges necessary for safe care of the accepted condition. You may withdraw from ongoing care at any time — but withdrawing is not medical advice to stop your medication, and some medications must not be stopped suddenly. Ask this practice or another qualified clinician before changing or stopping treatment.
• Pediatric care for children under 4 years old. (Children age 4–17 can be seen for select conditions when a parent or legal guardian completes the request and provides consent and the child's weight.)
• Mental-health crisis or psychiatric management.

Beginning and ending ongoing care. The physician may decline to accept you, or a particular condition, for ongoing management. If QuickVisitMD has accepted an ongoing-care relationship for a condition, either you or QuickVisitMD may end that relationship. Except where immediate termination is permitted or required by law, or is necessary to protect a patient, the physician, staff, or others, QuickVisitMD will give you documented advance notice and a reasonable opportunity to arrange replacement care. That notice will state the effective end date, how to obtain or transfer your records, where you may look for another clinician, and what follow-up remains medically necessary. During the notice period, the physician will assess what limited transition care or medication supply, if any, is clinically safe and legally permitted. No medication, refill, particular quantity, or successful placement with another clinician is guaranteed. QuickVisitMD will send records to you or to a clinician you choose on a valid request, and will cooperate in a clinically appropriate transfer of care. Emergency care is never provided through this service; call 911 or go to the nearest emergency department for an emergency.

If your concern falls into one of these categories, please don't submit a request here — an in-person primary care physician, specialist, urgent care, or emergency department is the appropriate care setting instead.

If the physician determines that a prescription medication is clinically appropriate, you understand and acknowledge that:

• All medications carry risks, including allergic reactions, side effects, and potential interactions with other medications, supplements, or medical conditions.
• The physician's prescribing decision relies on the accuracy and completeness of the health information, medication list, and allergy history you provide. Incomplete or inaccurate information may increase the risk of an adverse event.
• It is your responsibility to read the medication guide provided by the dispensing pharmacy and to ask the pharmacist any questions before taking the medication.
• QuickVisitMD can refill many routine, non-controlled medications when it is safe and clinically appropriate after a visit. For the defined set of non-controlled conditions this practice has approved for ongoing care, described above, the physician may also make the dose adjustments that are part of that ongoing management. QuickVisitMD does not provide prior authorizations for any medication. Outside that defined set of approved conditions, QuickVisitMD does not provide dose adjustments or ongoing medication management; for those needs, follow up with a local primary care provider.
• The physician may decline to prescribe if, in his clinical judgment, the potential risks outweigh the benefits or the condition requires in-person evaluation.

QuickVisitMD may use artificial intelligence (AI) tools and automated systems to assist with aspects of your care, including:

• Processing and organizing your intake responses.
• Generating draft clinical documentation for physician review.
• Translating clinical information between English and Spanish.
• Flagging potential clinical concerns for the physician's attention.

AI does not diagnose, treat, or make clinical decisions.All clinical determinations — including diagnosis, treatment plans, prescribing decisions, and referrals — are made by a licensed physician who personally reviews your request. AI outputs are treated as draft suggestions subject to the physician's independent clinical judgment. Direct identifiers (name, email, phone number, home address) are not sent to AI services. Clinical information necessary for documentation — including age, sex, symptoms, medications, allergies, medical history, and your intake responses — is sent to generate physician note drafts and patient instructions. Free-text clinical narratives you write may contain information you voluntarily include. All AI-generated content is reviewed and approved by the treating physician before becoming part of your medical record.

Your fee pays for physician evaluation of your request. Based on clinical judgment, the evaluation may result in a treatment plan, a request for more information, a decision to redirect you to in-person or higher-acuity care, or a decision that no treatment is appropriate through this service. The physician's clinical judgment — including a decision not to prescribe, refer, or continue care — is an earned professional service, and the fee is not refundable for an unfavorable clinical outcome alone.

QuickVisitMD is a self-pay service and does not bill insurance or submit claims for you. The asynchronous online visits provided here are a non-covered service under Medicare, Medicaid, and TRICARE (including Medicare Advantage), so no claim is filed with those programs; those patients pay directly and receive an itemized coded receipt. If you have commercial (private) insurance or are uninsured, you may request a superbill (physician NPI, the visit CPT code 99421-99423, and your ICD-10 diagnosis) to submit to your own plan for possible out-of-network self-reimbursement. QuickVisitMD does not submit the claim and does not guarantee reimbursement, which depends on your individual plan. By proceeding, you acknowledge that this is a private-pay arrangement. Any itemized receipt or superbill may also be used for HSA or FSA substantiation.

QuickVisitMD may request a photo of government-issued identification before completing an encounter, as required by applicable state telehealth and prescribing laws and to protect against fraud. If you choose not to provide identity verification when requested, the physician may decline to complete the encounter. You are responsible for the accuracy and truthfulness of the information you submit. Obtaining medical care, prescriptions, or documentation through false statements may constitute a criminal offense under Virginia Code § 18.2-186 and West Virginia Code § 61-3-24.

• In-person visit with a primary care provider or specialist.
• Urgent care center for acute, non-emergency concerns.
• Emergency department for emergencies.
• Live video or phone telemedicine services offered by other providers.

If you are having an emergency — including chest pain, shortness of breath, stroke symptoms, severe bleeding, suicidal thoughts, or any other life-threatening concern — please call 911 or go to the nearest emergency department immediately. Please don't use QuickVisitMD for emergencies.

If you or someone you know is experiencing a mental health crisis, call or text 988 (Suicide & Crisis Lifeline, available 24/7) or text HOME to 741741 (Crisis Text Line).

QuickVisitMD treats your information as confidential medical information consistent with HIPAA-level safeguards and applicable state privacy law. The visit, messages, images, and related documents become part of your medical record and may be retained and disclosed as permitted or required by law. See our Privacy & Confidentiality Notice.

The physician providing care through QuickVisitMD owes the same duty to exercise reasonable care, diligence, and skill as would be applicable if the service were provided in person, consistent with the accepted standard of care in the Commonwealth of Virginia and the State of West Virginia. The asynchronous modality does not reduce the physician's professional obligations; it changes only the method of communication. If the physician determines that a condition cannot be safely or adequately assessed through asynchronous messaging, you will be directed to in-person care.

If a technology failure, outage, or delivery delay prevents timely completion of your encounter, QuickVisitMD will make reasonable efforts to notify you and complete the encounter as soon as the issue is resolved. If the encounter cannot be completed due to a technology failure, the response-window refund policy described in the Terms of Service applies. You are not held responsible for technology failures on QuickVisitMD's side. If you experience difficulty submitting information, contact admin@quickvisitmd.com. In any clinical emergency, please don't wait for a technology issue to be resolved — call 911 or go to the nearest emergency department immediately.

You acknowledge that electronic transmission carries inherent risks including unauthorized access, interception, and technology failure. QuickVisitMD uses secure, encrypted systems and industry-standard protections — including HTTPS encryption in transit, encrypted storage at rest, and role-based access controls — to mitigate these risks, but no electronic system is entirely risk-free. By using the service you consent to electronic communication for care, payment, and administrative purposes.

QuickVisitMD does not record audio or video of any encounter. No live video session occurs. No audio session occurs except the brief physician-initiated identity-verification call required by West Virginia law for patients located in that state (see Section 3). Text-based messages, intake answers, and photographs you submit are retained as part of your medical record. Your images and health information will not be disseminated, shared for marketing, or disclosed to any third party without your written authorization, except as permitted or required by law (see the Privacy & Confidentiality Notice).

Your request is reviewed by Ankur Fadia, MD. Because QuickVisitMD uses asynchronous messaging rather than a live visit, there is no "room" with other individuals present. No other clinical staff, students, or observers participate in or observe the review of your request unless you are notified and consent in advance.

If the physician determines that a prescription is appropriate, your protected health information necessary for prescription fulfillment — including your name, date of birth, medication details, and pharmacy information — may be disclosed to your designated pharmacy as necessary to fill prescriptions and coordinate care, consistent with our privacy practices. This does not require a separate authorization.

QuickVisitMD is designed for single-episode evaluation of low-acuity concerns. It is not a substitute for an ongoing relationship with a primary care physician. After your encounter, you will receive an after-visit summary with your diagnosis, care plan, patient instructions, return precautions, and prescriptions (if any).

The physician-patient relationship created by a single-episode encounter concludes upon delivery of the after-visit summary and any expressly offered follow-up window, after which no ongoing duty of care exists for that encounter. If your condition requires follow-up, worsens, or changes after the encounter, you should seek care from a local primary care provider, urgent care center, or emergency department as clinically appropriate. Outside the defined set of non-controlled conditions this practice has approved for ongoing care, described in Section 6 above, QuickVisitMD does not provide ongoing management, follow-up visits, or chronic care, and you are responsible for establishing care with a local provider for those needs.

You may request a copy of your medical record at any time by submitting a records request through the medical records request page or by emailing admin@quickvisitmd.com.

You may withdraw this consent at any time by stopping the request flow, closing your account, or emailing admin@quickvisitmd.com. Withdrawal does not affect information already collected or actions already taken before the withdrawal is received, and does not affect your obligation to pay for care already provided. Refusing or withdrawing consent for telehealth does not affect your eligibility for future care with QuickVisitMD or any other provider.

You always have the right to decline telemedicine and seek in-person care instead. Choosing QuickVisitMD does not limit your ability to see another provider in person at any time. If you prefer in-person care, you may contact your primary care physician, visit an urgent care center, or go to the nearest emergency department.

By using QuickVisitMD and checking the consent box in the intake flow, you acknowledge that:

• You have read and understood this Telehealth Informed Consent.
• You understand the service is primarily asynchronous, with no live video or in-person examination. West Virginia encounters include a brief physician-conducted identity-verification call as required by state law; the clinical evaluation itself remains asynchronous.
• You understand the benefits, risks, limitations, and alternatives described above.
• You understand the service is not for emergencies.
• You are at least 18 years old — or you are the parent or legal guardian completing this request on behalf of a child age 4 to 17 — and the patient is physically located in Virginia or West Virginia. If you are completing this request for a child, you confirm you have the legal authority to consent to the child's medical care.
• You consent to telehealth care and to electronic communications for care and administrative purposes.
• You understand you may withdraw consent at any time without affecting eligibility for future care.
• You understand the same standard of care applies as for in-person care.
• You understand that your health information may be shared with your designated pharmacy for prescription fulfillment.
• You understand that QuickVisitMD is for single-episode evaluation and is not a substitute for ongoing primary care.

The short checkbox summary shown during intake refers back to this full consent. Your acceptance is recorded with a timestamp as part of your medical record.