Telehealth Consent

1. PURPOSE OF THIS CONSENT

This Informed Telehealth Consent Form (“Consent”) is provided to you by Antlia Inc. (“Antlia”, “we”, “us”, or “our”). Its purpose is to:

• Explain clearly what telehealth and virtual care services involve.
• Describe the anticipated benefits, potential risks, and limitations of receiving healthcare through a virtual platform.
• Obtain your informed consent to receive weight management healthcare services — including prescriber assessment and, where clinically appropriate, prescription issuance — through Antlia’s online platform.
• Ensure you understand your rights, including your right to withdraw consent at any time.

In this Consent, “you” and “your” refer to the individual member submitting a health assessment and receiving services through the Antlia platform. “Prescriber” refers to the licensed Canadian physician or nurse practitioner who reviews your assessment and makes independent clinical decisions.

2. WHAT IS TELEHEALTH / VIRTUAL CARE?

Telehealth — also referred to as virtual care or telemedicine — is the delivery of healthcare services using secure electronic communications and information technology between a licensed healthcare provider and a patient who are not in the same physical location.

Through Antlia’s platform, telehealth services include:

• Your completion of a secure, confidential online health assessment (the “Assessment”).
• Asynchronous review of your Assessment by a licensed Canadian Prescriber registered in your province.
• Electronic clinical decision-making and, where appropriate, issuance of a prescription for Health Canada–approved weight management medication.
• Transmission of prescriptions to your selected licensed Canadian pharmacy.
• Follow-up care coordination and ongoing clinical support through the platform.
• Electronic communications between you and your Prescriber or Antlia’s care team via the platform’s secure messaging system.

3. ANTICIPATED BENEFITS OF TELEHEALTH

Receiving weight management care through Antlia’s telehealth platform may offer the following benefits:

• Convenient access to licensed Canadian prescribers from the comfort of your home, without the need for an in-person clinic appointment.
• Reduced wait times compared to traditional in-person specialist referrals.
• Access to clinically evaluated, Health Canada–approved weight management medications that may not otherwise be easily accessible.
• Flexibility to complete your health assessment at a time that suits your schedule.
• Greater privacy and discretion in managing a sensitive health concern.
• Ongoing follow-up support and care coordination without requiring repeated in-person visits.
• Improved access to weight management care regardless of your geographic location within Canada.

4. POTENTIAL RISKS AND LIMITATIONS OF TELEHEALTH

You should be aware of the following potential risks and limitations associated with receiving healthcare through a telehealth platform:

• Clinical limitations: The Prescriber reviews your assessment based solely on the information you provide. Without an in-person physical examination, certain conditions may not be identifiable. The Prescriber may be unable to diagnose or treat every condition through virtual care alone.
• Information accuracy: The quality and completeness of your Assessment directly affects the Prescriber’s ability to make appropriate clinical decisions. Inaccurate, incomplete, or misleading information may result in an inappropriate clinical determination and could pose a risk to your health.
• Technology failures: Platform outages, internet connectivity issues, software errors, or device malfunctions may interrupt or delay your access to the Services or the Prescriber’s ability to review your Assessment in a timely manner.
• Security risks: Despite our use of encryption and security safeguards, no electronic system is completely immune to unauthorized access. Electronic communications — including messages and emails — may carry an inherent risk of interception or unintended disclosure.
• Emergency situations: Virtual care is not appropriate for emergency or life-threatening medical situations. If you are experiencing a medical emergency, you must call 911 or attend your nearest emergency department immediately.
• Prescription limitations: Applicable provincial and federal regulations govern what may be prescribed through a telehealth platform. Not all medications or treatments may be available through virtual care. Your Prescriber will determine what is clinically and legally appropriate.
• Delayed response: Because Antlia uses an asynchronous (non-real-time) assessment model, there may be a delay between the submission of your Assessment and its clinical review. Antlia’s platform is not suitable for urgent or time-sensitive medical needs.
• Drug interactions: The Prescriber reviews only the information you provide. If you do not fully disclose all current medications, supplements, or medical conditions, the risk of adverse drug interactions or other clinical errors increases.
• Laboratory and diagnostic limitations: The Prescriber cannot order or review in-person diagnostic tests or physical measurements through the platform. This may limit diagnostic precision in some circumstances.

5. INDEPENDENCE OF PRESCRIBERS

All Prescribers who review assessments through the Antlia platform are independent licensed healthcare professionals — physicians or nurse practitioners — registered with and in good standing with their applicable provincial regulatory college (e.g., the College of Physicians and Surgeons or the College of Nurses).

• Prescribers are not employees of Antlia. Antlia provides the technology platform; Prescribers exercise their own independent clinical judgment in reviewing your Assessment and making all clinical decisions.
• Your Prescriber may be a nurse practitioner rather than a physician. Nurse practitioners are qualified, regulated, and independently licensed to prescribe medications within their scope of practice.
• Not every assessment will result in the issuance of a prescription. The Prescriber may determine that prescription medication is not clinically appropriate for you, or may request additional information before making a determination.
• Your Prescriber may refer you to an in-person healthcare provider or specialist if they determine your needs cannot be safely or appropriately addressed through virtual care.
• Antlia does not direct, override, or influence the clinical decisions of any Prescriber.

6. WEIGHT MANAGEMENT MEDICATIONS AND PRESCRIPTIONS

Antlia’s platform facilitates access to prescriptions for Health Canada–approved weight management medications only. You acknowledge and understand the following:

• Only Health Canada–approved medications will be prescribed through this platform. Antlia does not facilitate prescriptions for compounded, unapproved, or experimental medications.
• Prescriptions are valid for and may only be used by the individual named on the prescription. Prescriptions may not be shared, transferred, or used by any other person.
• Your prescription will be transmitted electronically to the licensed pharmacy you select, or to Antlia’s pharmacy partner. You are free to choose any licensed Canadian pharmacy to fill your prescription.
• All weight management medications carry potential side effects. Your Prescriber will consider your health history to minimize risk, but cannot guarantee you will not experience side effects.
• You must inform your Prescriber of all current medications, supplements, and health conditions to minimize the risk of adverse drug interactions.
• Prescription medications for weight management are not suitable for everyone. Your eligibility is determined solely by the Prescriber based on clinical review of your Assessment.

IF YOU EXPERIENCE A SEVERE OR UNEXPECTED REACTION TO ANY PRESCRIBED MEDICATION, STOP TAKING THE MEDICATION AND CALL 911 OR GO TO YOUR NEAREST EMERGENCY DEPARTMENT IMMEDIATELY. THEN CONTACT ANTLIA’S CARE TEAM AT SUPPORT@ANTLIA.CA.

7. DATA PRIVACY AND HEALTH INFORMATION SECURITY

Antlia takes the privacy and security of your personal health information seriously. The following measures are in place to protect your information:

• All personal and health information transmitted through our platform is encrypted using industry-standard TLS/SSL encryption in transit and at rest.
• Your health information is accessible only to your assigned Prescriber and authorized Antlia personnel on a need-to-know basis.
• Your personal health information will not be disclosed to any third party without your consent, except as required or permitted by applicable law, or as necessary for the provision of clinical and pharmacy services.
• Antlia complies with applicable Canadian privacy legislation, including PIPEDA and applicable provincial health privacy statutes.

Please be aware that no electronic communication system — including email or messaging — can be guaranteed to be completely secure. By using our platform and consenting to electronic communications, you accept this inherent limitation.

For full details on how we collect, use, and protect your information, please review Antlia’s Privacy Policy at antlia.ca/privacy.

8. ACCESS TO YOUR HEALTH RECORDS

By accepting this Consent, you authorize your Prescriber and Antlia’s associated clinical staff to access, retrieve, and review:

• The health assessment and personal health information you submit through the Antlia platform.
• Any prior assessment records or clinical communications you have submitted through the Antlia platform.
• Any other health information you have voluntarily provided to Antlia in connection with your care.

This access is for the sole purpose of enabling the Prescriber to make a safe and informed clinical decision regarding your weight management care. Antlia does not automatically access external health records (e.g., from other physicians or healthcare systems) without your separate express authorization.

You have the right to access, review, and request correction of your health records held by Antlia. To make such a request, please contact our Privacy Officer at support@antlia.ca.

9. EMERGENCY AND URGENT CARE

ANTLIA’S PLATFORM IS NOT SUITABLE FOR EMERGENCY OR URGENT CARE. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL 911 OR ATTEND YOUR NEAREST EMERGENCY DEPARTMENT IMMEDIATELY.

Antlia’s telehealth model involves asynchronous assessment review, meaning your Prescriber does not monitor the platform in real time. Prescribers may not respond to communications immediately.

If you are not experiencing an emergency but have an urgent clinical question or concern about a prescribed medication, you may contact Antlia’s care team at support@antlia.ca. Response times are [within 24 hours].

10. YOUR RIGHTS AS A PATIENT

You have the following rights in connection with your telehealth care through Antlia:

• Right to informed consent: You have the right to receive clear information about the nature of the Services, including benefits, risks, and limitations, before consenting to care — which this document provides.
• Right to ask questions: You have the right to ask questions about your Assessment, the medications recommended, or the care you receive before accepting any treatment.
• Right to decline treatment: You have the right to decline a prescription or any other clinical recommendation at any time.
• Right to withdraw consent: You may withdraw your consent to telehealth services at any time by providing written notice to Antlia at support@antlia.ca. Withdrawal of consent will take effect upon receipt and will not affect any actions taken by Antlia or your Prescriber prior to receipt of your withdrawal.
• Right to seek alternative care: You are free at any time to seek care from an in-person healthcare provider or another service of your choice. Withdrawal of consent from Antlia’s Services will not affect your right to seek care elsewhere.
• Right to access your records: You have the right to request a copy of your health records held by Antlia, free of charge.
• Right to privacy: Your health information will be handled in accordance with Antlia’s Privacy Policy and applicable Canadian privacy law.

11. ALTERNATIVES TO TELEHEALTH

Telehealth through Antlia’s platform is one option for accessing weight management care. Alternatives include:

• Consulting your family physician or general practitioner in person for a referral and assessment.
• Attending a specialized obesity medicine clinic or bariatric centre.
• Consulting with an endocrinologist, internist, or other specialist through your provincial healthcare system.
• Participating in a medically supervised weight management program through a hospital or community health centre.
• Using another telehealth provider of your choice.

You are free to choose any alternative at any time and may discuss alternative options with your Prescriber.

12. RECORDINGS AND COMMUNICATIONS

Antlia’s platform operates on an asynchronous model — you submit your written Assessment, and your Prescriber reviews and responds in writing. There are no live video or audio consultations as part of the standard assessment process.

You agree that:

• You will not record, screenshot, or otherwise capture any clinical communications, assessment feedback, or prescriber notes without the express written consent of Antlia and your Prescriber.
• All clinical communications through the platform are confidential and intended solely for your personal use.
• You will use Antlia’s secure platform messaging system — not personal email or social media — for all clinical communications.

13. FINANCIAL RELATIONSHIPS AND TRANSPARENCY

In the interest of full transparency, you acknowledge the following:

• Antlia Health Inc. has a business and financial relationship with the professional entities that employ or contract with the Prescribers who review assessments through the platform.
• Antlia may have a commercial relationship with pharmacy partners who fulfill prescriptions issued through the platform. However, you are completely free to have your prescription filled at any licensed Canadian pharmacy of your choice — including your local pharmacy — by providing the prescription to that pharmacy directly.
• Antlia’s fee structure is disclosed to you before you complete your assessment submission. The assessment fee covers the provision of the clinical review service and is charged when an assessment is submitted however a refund is issued when assessment is denied.

14. YOUR ACKNOWLEDGMENTS

By clicking “Submit My Assessment” or otherwise proceeding with the Services, you acknowledge, confirm, and agree to each of the following:

1. You have read and fully understand this Informed Telehealth Consent, including the purpose, anticipated benefits, potential risks, and limitations of receiving healthcare through Antlia’s telehealth platform.
2. You understand that all healthcare services provided through Antlia are delivered exclusively via virtual care, and that Antlia does not provide in-person clinical services.
3. You understand that your Prescriber may be a nurse practitioner and not a physician, and you consent to receive care from a licensed non-physician provider where applicable.
4. You understand that not every assessment will result in the issuance of a prescription, and that the Prescriber may request additional information, recommend alternative care, or decline to prescribe based on their independent clinical judgment.
5. You have provided truthful, accurate, complete, and current information in your health assessment, and you understand that the quality of your care depends on the accuracy of the information you provide.
6. You will inform your Prescriber of all current medications, supplements, allergies, and relevant medical history, including any care you are receiving from other healthcare providers.
7. You understand that Antlia’s platform is not suitable for emergency or urgent care, and that you will call 911 or attend the nearest emergency department in the event of a medical emergency.
8. You understand the risks of electronic transmission of personal health information and accept these risks by choosing to use the platform.
9. You understand that no guarantee of specific results, weight loss outcomes, or clinical benefits can be made, and that your condition may not improve and could in some cases worsen.
10. You have the right to withdraw consent at any time by providing written notice to Antlia at support@antlia.ca, without penalty or loss of health benefits to which you are entitled, but you understand that withdrawal of consent means you will no longer be able to receive Services through Antlia.
11. You understand that Antlia has a financial relationship with prescribing entities and pharmacy partners, and that you are free to have your prescription filled at any licensed Canadian pharmacy of your choice.
12. You are 18 years of age or older, are currently located in a Canadian province or territory where Antlia operates, and have the legal capacity to provide this consent.

15. CONSENT CONFIRMATION

Your digital acceptance of this Consent — by clicking “Submit My Assessment” or using any other acceptance mechanism presented through the platform — constitutes your legally binding agreement to this Informed Telehealth Consent and carries the same legal weight as a handwritten signature under applicable Canadian law.

If you have any questions about this Consent before proceeding, please do not submit your Assessment. Instead, contact Antlia’s care team at support@antlia.ca and a member of our team will be happy to assist you.

For your records, a summary of key information from this Consent:

Platform: Antlia Health Inc. — antlia.ca

Service Type: Asynchronous telehealth assessment for weight management

Prescribers: Independent licensed Canadian physicians and/or nurse practitioners

Medications: Health Canada–approved weight management medications only

Emergencies: CALL 911 or go to the nearest Emergency Department

Support: support@antlia.ca

Withdraw Consent: Written notice to support@antlia.ca at any time