Telehealth Consent and Practice Policies Agreement
Telehealth Consent and Practice Policies Agreement
Effective Date: Jan 20, 2026
This document describes what you can expect and your rights as a patient of Arima Provider Group. The following walks you through our services and clinical programs, and how they will benefit and impact you.
General Information
Sleep Clinics of America, P.C., Sleep Clinics of Oregon, P.C., Sleep Clinics of Kansas, P.C., Sleep Medicine Clinic of America New York, P.C., Sleep Clinics of California, P.C. (collectively, “Arima Provider Group”, “we”, “our” or “us”) provides technology-enabled sleep healthcare services via telehealth through its engaged clinicians and support staff (the “Care Team”) with non-clinical support from its technology partner, Arima Health Technology, Inc. (“Arima”). Arima does not provide clinical services; it performs administrative, payment, and other supportive activities for Arima Provider Group. When you request to receive services from an Arima Provider Group clinician, those services are outlined by this Telehealth Consent and Practice Policies Agreement (this “Agreement”), as well as the discussions between you and your clinician(s). It is important for you to read this document and discuss any questions you might have with your Arima Provider Group care team. If you agree to these terms, we will assume that you have read, understood, and agree to the contents of this Agreement.
Our Services and Technology
When you become a patient of Arima Provider Group (a “Member”), you will be given access our online platform (the “Platform”) and our Care Team. The Platform provides personalized content and interactive resources for you, and connects you to our Care Team. Your Care Team will be with you every step of the way and work collectively to support high quality, effective care. For purposes of this Agreement, “you” means you as the patient, or as the lawful guardian, conservator, or custodian on behalf of your family member (“Family Member”) to the extent you are signing this Agreement on behalf of a Family Member.
You are entitled to receive information from your Care Team about the methods of treatment, the credentials of members of your Care Team, the techniques used, the duration of your treatment (if known), and the fee structure. You may terminate treatment at any time.
Responsibility for your overall medical care should remain with your local primary care doctor, if you have one, and we strongly encourage you to locate one if you do not have a primary care doctor.
Company may use artificial intelligence programs to assist with patient intake, charting, scheduling, and other administrative or support tasks. You understand that while the artificial intelligence program may provide informational content, it will not provide medical or clinical advice and is not a licensed clinical provider. If you are seeking medical or clinical advice, please reach out to an Arima Medical Group clinician or your primary care provider.
Telehealth Informed Consent - Risks and Benefits
Your Care team will provide sleep health services via telehealth using video calls, voice calls, and asynchronous messaging services. They may prescribe you medication or recommend other treatment, as needed.
PLEASE NOTE: OUR CARE TEAM DOES NOT ADDRESS EMERGENCIES VIA TELEHEALTH. IF YOU ARE EXPERIENCING SUICIDAL OR HOMICIDAL THOUGHTS OR CONSIDERING HARMING YOURSELF OR OTHERS, IMMEDIATELY DIAL 9-8-8 FOR THE NATIONAL SUICIDE AND CRISIS PREVENTION HOTLINE OR DIAL 9-1-1 FOR EMERGENCY SERVICES. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY OR ARE OTHERWISE IN IMMINENT DANGER, IMMEDIATELY DIAL 9-1-1 AND/OR GO TO THE NEAREST EMERGENCY ROOM.
You will have an opportunity to develop ongoing care relationships with your Arima Provider Group clinician(s), however, your initial encounter may begin as a consultation (e.g. to determine the most appropriate treatment setting for you to receive care) and will not necessarily give rise to an ongoing treatment relationship. In that case, the Care Team will work with you to identify the appropriate care.
Telehealth will involve electronic communication of your personal medical information to other health practitioners who may be located in other areas, including out of state. All laws and protections for in-person medical visits also apply to telehealth visits. This includes confidentiality of information, access to medical records, and sharing of information that could identify you personally.
You have a right to know who is attending each telehealth visit. You may decide that you do not want to use telehealth services at any time. This will not make you lose your health program benefits or your rights to future health care.
Telehealth may offer benefits such as improved access to care, convenience, and more efficient evaluation and management, including access to specialty expertise as appropriate. However, as with any health service, there are potential risks associated with using technology. These risks include service problems and delays in evaluation or treatment due to technology or internet failures, not having enough information to make health care decisions, rare security errors, and other risks. You understand that the Care Team relies on you to provide accurate information and that we are not responsible for issues resulting from errors and omissions in the relay of this information.
If you need to receive follow-up care, assistance in the event of an adverse reaction to the treatment, or in the event of an inability to communicate as a result of a technological or equipment failure, please contact Arima Provider Group through the patient portal or via email at contact@arimahealth.com.
Telehealth may not be appropriate for all conditions and treatments. We can provide assistance to find in-person care if we determine telehealth is not clinically appropriate.
Payment and Billing
You understand that if your health insurance (including Medicare) coverage does not cover the charges for your services in full or at all, you may be fully or partially responsible for payment. If your health insurance requires you to pay a deductible, copayment or coinsurance for your healthcare, the usual cost-sharing rules will apply. Please check with your health plan to determine if any services will be reimbursed. If you request, we will work with you to determine what your charges will be. If you are paying for your visit without insurance, we will inform you of any amounts owed.
You agree that Medicare, health plans and any other persons or organization (third parties) who pay any part of your Arima Provider Group bill are authorized to pay these amounts directly to us (instead of you). You agree that we may submit claims to these third parties on your behalf. You understand that you must pay us for services we provide that are not paid by your insurance or other third parties (“Your Costs”), unless state or federal regulations do not allow this.
By providing us with your credit card information and associated billing information, you are authorizing us to save on file and charge your credit card for agreed upon purchases and your continued use of the services (e.g. Your Costs including any copayments, deductibles and co-insurance, etc. for any and all visits with us) with no additional consent required by you. If your health plan or another third party has arranged with us to pay the fee or any portion of the fee, or if the fee is pursuant to some other arrangement with us, that fee adjustment will be reflected in the fee that you are ultimately charged.
Scheduling and Attendance
We understand you may have to reschedule or cancel an appointment from time to time. We ask that you notify us at least 24 hours in advance of your scheduled appointment. If you do not notify us at least 24 hours in advance, we will charge you a $50 cancellation fee. If you repeatedly miss scheduled appointments and we are unable to contact you for a significant period of time, you understand that you may be terminated from the practice and will no longer be considered a patient of Arima Provider Group.
Other Acknowledgements
Arima Provider Group will rely on all information you provide as accurate and complete. You understand that Arima Provider Group will use such information in its delivery of the Services to you. The inaccuracy of any such information you provide to Arima Provider Group may impact the efficiency and accuracy of the Services.
Arima Provider Group will provide you with information related to your diagnosis, treatment and ongoing care. The success of your treatment is dependent on your review of this information, and you agree to review all such information.
Some parts of the Services may require obtaining tests at a testing facility or lab that are not owned or controlled by Arima Provider Group (e.g., labs, bloodwork, sleep test).
It is Arima Provider Group’s policy to report, in accordance with applicable law, any disclosures that may cause a reasonable suspicion of abuse or neglect of a person belonging to a vulnerable population.
There is a risk of technical failures during the telehealth encounter beyond the control of Arima Provider Group. You agree to hold harmless Arima Provider Group for delays in evaluation or for information lost due to such technical failures that are beyond Arima Provider Group’s reasonable control.
Complaint Policy
You have the right to communicate grievances regarding your care. Should you wish to make a formal complaint about one of your care providers you may do so in writing and submit the concern to us at:
Attn: Arima Health
contact@arimahealth.com
If you wish to submit a complaint about your clinician, you can contact Arima Provider Group for information on how to submit a complaint to the relevant state licensure board.
Access To Records
You have the right to request a copy of your medical records. You can request to obtain or send a copy of your medical records to your primary care or other designated health care provider by contacting us at:
Attn: Arima Health
contact@arimahealth.com
A copy will be provided to you at reasonable cost of preparation, shipping and delivery.
Privacy Practices
We follow federal healthcare privacy and security laws and protect your health information. We work hard to make sure that your personal information is secure. We use standard physical, electronic, and business security methods to help prevent access to your health information by people who should not see it. But we cannot promise that data sent over the Internet or through a data storage facility will be perfectly secure. So, although we try to protect your personal information, we cannot guarantee the security of any information you send to us. You can read more information about our use of health information and other personal information in our Notice of Health Information Privacy Practices (“NPP”).
By clicking “I agree”, you agree that we may share your health records and healthcare information with the following individuals under the following circumstances without further notice to you while you are a Member of Arima Provider Group:
With your other healthcare providers (including your primary care provider), either directly or through our participation in health information exchanges, for healthcare coordination, payment, operations and treatment purposes. This may include information relating to genetic tests, substance or alcohol use, mental health, communicable diseases, HIV/AIDS and other health conditions. You understand that in most instances we will send such records to your primary care provider after each visit.
With other individuals involved in your care such as caregivers or family members.
With your health plan, either directly or through our participation in health information exchanges, for healthcare payment, coordination, operations and treatment purposes (such as eligibility verification, processing your claims, and audits of our services). This may include information relating to genetic testing, substance or alcohol use, mental health, communicable diseases, HIV/AIDS and other health conditions.
As otherwise permitted in our Notice of Health Information Privacy Practices and by applicable law.
By clicking “I agree”, you agree to let us share your records as described above and acknowledge receipt of the Notice of Health Information Privacy Practices. Dissemination of any patient identifiable images or information from the telehealth visit to researchers or other educational entities will not occur without your affirmative consent.
SMS and Email Communications
By providing your phone number and email, you consent to receive from Arima Provider Group and Arima promotional and marketing texts, other text messages, and emails related to our products and services such as appointment reminders and notifications. You understand SMS text messages and emails are not always secure because they travel over networks that we do not control, messaging frequency may vary, and SMS message and data rates may apply. This consent is not required for you to receive our products and services.
You may ask us to stop sending you marketing texts at any time by contacting us at contact@arimahealth.com or clicking the unsubscribe link (where available) in one of our messages.
Agreement and Consent
If you have questions about any of the contents of this Agreement, our procedures, or your role in this process, please discuss them with your Care Team. Remember that the best way to assure quality treatment is to keep communication open and direct with your clinician(s).
By clicking “I accept”, you indicate that you have read and understood this document, and that you agree to abide by its terms. Further, you certify that if you are signing as a personal representative of the Member, you have legal authority to provide consent for the treatment of the Member.
Additional State-Specific Notifications:
Alaska: You understand your primary care provider may obtain a copy of your records of your telehealth encounter. (Alaska Stat. § 08.64.364).
Arizona: You understand that all medical records resulting from a telemedicine consultation are part of your medical record. (A.R.S. § 12-2291.)
Colorado: If you want to register a formal complaint about a provider, you should file at: https://dpo.colorado.gov/FileComplaint.
Connecticut: You understand your primary care provider may obtain a copy of your records of your telehealth encounter, and that you can revoke your consent at any time. (Conn. Gen. Stat. Ann. § 19a-906).
D.C.: You have been informed of alternate forms of communication between you and a physician for urgent matters. (D.C. Mun. Regs. tit. 17, § 4618.10).
Georgia: You have been given clear, appropriate, accurate instructions on follow-up in the event of needed emergent care related to the treatment. (Ga. Comp. R. & Regs. 360-3-.07(7)).
Iowa: If you want to register a formal complaint about a provider, visit: https://medicalboard.iowa.gov/consumers/filing-complaint.
Idaho: If you want to register a formal complaint about a provider, visit: https://dopl.idaho.gov/filing-a-complaint/.
Illinois: If you want to register a formal complaint about a provider, visit: https://idfpr.illinois.gov/admin/dpr/complaint.html.
Indiana: If you want to register a formal complaint about a provider, visit: https://inoag.my.salesforce-sites.com/ConsumerComplaintForm.
Kansas: If you have a primary care provider or other treating physician, the person providing telemedicine services must send within three business days a report to such primary care or other treating physician of the treatment and services rendered during the encounter. (Kan. Stat. Ann. § 40-2,212(2)(d)(2)(A)). Complaint process: http://www.ksbha.org/complaints.shtml.
Kentucky: If you want to register a formal complaint about a provider, visit: https://kbml.ky.gov/grievances/Pages/default.aspx.
Louisiana: You understand the role of other health care providers who may be present during the consultation other than the telehealth provider. (46 La. Admin. Code Pt XLV, § 7511).
Maine: If you want to register a formal complaint about a provider, visit: https://www.maine.gov/md/complaint/file-complaint.
Maryland: Telehealth services may not be provided based solely on an online questionnaire. Complaint form: https://www.mbp.state.md.us/forms/complaint.pdf.
Nebraska: All confidentiality protections apply to the telehealth consultation. You may access medical information resulting from the telehealth consultation as provided by law. No dissemination of identifiable images or information is permitted without written consent. You may request an in-person consult immediately after the telehealth consult and will be informed if one is unavailable. Complaint process: https://dhhs.ne.gov/Pages/Complaints.aspx.
New Hampshire: You understand the telehealth provider may forward your medical records to your primary care or treating provider. (N.H. Rev. Stat. § 329:1-d).
New Jersey: You have the right to request a copy of your medical information and understand it may be forwarded directly to your primary care provider or other provider of record. (N.J. Rev. Stat. Ann. § 45:1-62).
Ohio: You understand the telehealth provider may forward your medical records to your primary care or treating provider. (Ohio Admin. Code 4731-11-09(C)).
Oklahoma: Complaint resources: http://www.okmedicalboard.org/complaint and https://www.ok.gov/osboe/faqs.html.
Rhode Island: You understand the permitted types of transmissions, when alternate communication or office visits should be used, security measures, and potential risks to privacy. (Rhode Island Medical Board Guidelines).
South Carolina: You understand your medical records may be distributed in accordance with applicable law to other treating health care practitioners. (S.C. Code Ann. § 40-47-37).
South Dakota: You received disclosures regarding delivery models, treatment methods or limitations, and discussed diagnosis and risks/benefits of treatment options. (S.D. Codified Laws § 34-52-3).
Texas: You understand your medical records may be sent to your primary care physician. (Tex. Occ. Code Ann. § 111.005). You have been informed of the following notice:
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.
Utah: You understand fee disclosures, information rights, emergency limitations, privacy risks, and security standards. You may access, supplement, amend, request copies, and request transfer of your telemedicine medical record. (Utah Admin. Code r. 156-1-603).
Virginia: You acknowledge receipt of required security and privacy disclosures and provide consent to forward identifiable information to a third party. (Virginia Board of Medicine Guidance Document 85-12).
Vermont: You understand you have the right to receive a consult with a distant-site provider and may request one immediately or within a reasonable time. Complaint process: http://www.healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint.
This document describes what you can expect and your rights as a patient of Arima Provider Group. The following walks you through our services and clinical programs, and how they will benefit and impact you.
General Information
Sleep Clinics of America, P.C., Sleep Clinics of Oregon, P.C., Sleep Clinics of Kansas, P.C., Sleep Medicine Clinic of America New York, P.C., Sleep Clinics of California, P.C. (collectively, “Arima Provider Group”, “we”, “our” or “us”) provides technology-enabled sleep healthcare services via telehealth through its engaged clinicians and support staff (the “Care Team”) with non-clinical support from its technology partner, Arima Health Technology, Inc. (“Arima”). Arima does not provide clinical services; it performs administrative, payment, and other supportive activities for Arima Provider Group. When you request to receive services from an Arima Provider Group clinician, those services are outlined by this Telehealth Consent and Practice Policies Agreement (this “Agreement”), as well as the discussions between you and your clinician(s). It is important for you to read this document and discuss any questions you might have with your Arima Provider Group care team. If you agree to these terms, we will assume that you have read, understood, and agree to the contents of this Agreement.
Our Services and Technology
When you become a patient of Arima Provider Group (a “Member”), you will be given access our online platform (the “Platform”) and our Care Team. The Platform provides personalized content and interactive resources for you, and connects you to our Care Team. Your Care Team will be with you every step of the way and work collectively to support high quality, effective care. For purposes of this Agreement, “you” means you as the patient, or as the lawful guardian, conservator, or custodian on behalf of your family member (“Family Member”) to the extent you are signing this Agreement on behalf of a Family Member.
You are entitled to receive information from your Care Team about the methods of treatment, the credentials of members of your Care Team, the techniques used, the duration of your treatment (if known), and the fee structure. You may terminate treatment at any time.
Responsibility for your overall medical care should remain with your local primary care doctor, if you have one, and we strongly encourage you to locate one if you do not have a primary care doctor.
Company may use artificial intelligence programs to assist with patient intake, charting, scheduling, and other administrative or support tasks. You understand that while the artificial intelligence program may provide informational content, it will not provide medical or clinical advice and is not a licensed clinical provider. If you are seeking medical or clinical advice, please reach out to an Arima Medical Group clinician or your primary care provider.
Telehealth Informed Consent - Risks and Benefits
Your Care team will provide sleep health services via telehealth using video calls, voice calls, and asynchronous messaging services. They may prescribe you medication or recommend other treatment, as needed.
PLEASE NOTE: OUR CARE TEAM DOES NOT ADDRESS EMERGENCIES VIA TELEHEALTH. IF YOU ARE EXPERIENCING SUICIDAL OR HOMICIDAL THOUGHTS OR CONSIDERING HARMING YOURSELF OR OTHERS, IMMEDIATELY DIAL 9-8-8 FOR THE NATIONAL SUICIDE AND CRISIS PREVENTION HOTLINE OR DIAL 9-1-1 FOR EMERGENCY SERVICES. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY OR ARE OTHERWISE IN IMMINENT DANGER, IMMEDIATELY DIAL 9-1-1 AND/OR GO TO THE NEAREST EMERGENCY ROOM.
You will have an opportunity to develop ongoing care relationships with your Arima Provider Group clinician(s), however, your initial encounter may begin as a consultation (e.g. to determine the most appropriate treatment setting for you to receive care) and will not necessarily give rise to an ongoing treatment relationship. In that case, the Care Team will work with you to identify the appropriate care.
Telehealth will involve electronic communication of your personal medical information to other health practitioners who may be located in other areas, including out of state. All laws and protections for in-person medical visits also apply to telehealth visits. This includes confidentiality of information, access to medical records, and sharing of information that could identify you personally.
You have a right to know who is attending each telehealth visit. You may decide that you do not want to use telehealth services at any time. This will not make you lose your health program benefits or your rights to future health care.
Telehealth may offer benefits such as improved access to care, convenience, and more efficient evaluation and management, including access to specialty expertise as appropriate. However, as with any health service, there are potential risks associated with using technology. These risks include service problems and delays in evaluation or treatment due to technology or internet failures, not having enough information to make health care decisions, rare security errors, and other risks. You understand that the Care Team relies on you to provide accurate information and that we are not responsible for issues resulting from errors and omissions in the relay of this information.
If you need to receive follow-up care, assistance in the event of an adverse reaction to the treatment, or in the event of an inability to communicate as a result of a technological or equipment failure, please contact Arima Provider Group through the patient portal or via email at contact@arimahealth.com.
Telehealth may not be appropriate for all conditions and treatments. We can provide assistance to find in-person care if we determine telehealth is not clinically appropriate.
Payment and Billing
You understand that if your health insurance (including Medicare) coverage does not cover the charges for your services in full or at all, you may be fully or partially responsible for payment. If your health insurance requires you to pay a deductible, copayment or coinsurance for your healthcare, the usual cost-sharing rules will apply. Please check with your health plan to determine if any services will be reimbursed. If you request, we will work with you to determine what your charges will be. If you are paying for your visit without insurance, we will inform you of any amounts owed.
You agree that Medicare, health plans and any other persons or organization (third parties) who pay any part of your Arima Provider Group bill are authorized to pay these amounts directly to us (instead of you). You agree that we may submit claims to these third parties on your behalf. You understand that you must pay us for services we provide that are not paid by your insurance or other third parties (“Your Costs”), unless state or federal regulations do not allow this.
By providing us with your credit card information and associated billing information, you are authorizing us to save on file and charge your credit card for agreed upon purchases and your continued use of the services (e.g. Your Costs including any copayments, deductibles and co-insurance, etc. for any and all visits with us) with no additional consent required by you. If your health plan or another third party has arranged with us to pay the fee or any portion of the fee, or if the fee is pursuant to some other arrangement with us, that fee adjustment will be reflected in the fee that you are ultimately charged.
Scheduling and Attendance
We understand you may have to reschedule or cancel an appointment from time to time. We ask that you notify us at least 24 hours in advance of your scheduled appointment. If you do not notify us at least 24 hours in advance, we will charge you a $50 cancellation fee. If you repeatedly miss scheduled appointments and we are unable to contact you for a significant period of time, you understand that you may be terminated from the practice and will no longer be considered a patient of Arima Provider Group.
Other Acknowledgements
Arima Provider Group will rely on all information you provide as accurate and complete. You understand that Arima Provider Group will use such information in its delivery of the Services to you. The inaccuracy of any such information you provide to Arima Provider Group may impact the efficiency and accuracy of the Services.
Arima Provider Group will provide you with information related to your diagnosis, treatment and ongoing care. The success of your treatment is dependent on your review of this information, and you agree to review all such information.
Some parts of the Services may require obtaining tests at a testing facility or lab that are not owned or controlled by Arima Provider Group (e.g., labs, bloodwork, sleep test).
It is Arima Provider Group’s policy to report, in accordance with applicable law, any disclosures that may cause a reasonable suspicion of abuse or neglect of a person belonging to a vulnerable population.
There is a risk of technical failures during the telehealth encounter beyond the control of Arima Provider Group. You agree to hold harmless Arima Provider Group for delays in evaluation or for information lost due to such technical failures that are beyond Arima Provider Group’s reasonable control.
Complaint Policy
You have the right to communicate grievances regarding your care. Should you wish to make a formal complaint about one of your care providers you may do so in writing and submit the concern to us at:
Attn: Arima Health
contact@arimahealth.com
If you wish to submit a complaint about your clinician, you can contact Arima Provider Group for information on how to submit a complaint to the relevant state licensure board.
Access To Records
You have the right to request a copy of your medical records. You can request to obtain or send a copy of your medical records to your primary care or other designated health care provider by contacting us at:
Attn: Arima Health
contact@arimahealth.com
A copy will be provided to you at reasonable cost of preparation, shipping and delivery.
Privacy Practices
We follow federal healthcare privacy and security laws and protect your health information. We work hard to make sure that your personal information is secure. We use standard physical, electronic, and business security methods to help prevent access to your health information by people who should not see it. But we cannot promise that data sent over the Internet or through a data storage facility will be perfectly secure. So, although we try to protect your personal information, we cannot guarantee the security of any information you send to us. You can read more information about our use of health information and other personal information in our Notice of Health Information Privacy Practices (“NPP”).
By clicking “I agree”, you agree that we may share your health records and healthcare information with the following individuals under the following circumstances without further notice to you while you are a Member of Arima Provider Group:
With your other healthcare providers (including your primary care provider), either directly or through our participation in health information exchanges, for healthcare coordination, payment, operations and treatment purposes. This may include information relating to genetic tests, substance or alcohol use, mental health, communicable diseases, HIV/AIDS and other health conditions. You understand that in most instances we will send such records to your primary care provider after each visit.
With other individuals involved in your care such as caregivers or family members.
With your health plan, either directly or through our participation in health information exchanges, for healthcare payment, coordination, operations and treatment purposes (such as eligibility verification, processing your claims, and audits of our services). This may include information relating to genetic testing, substance or alcohol use, mental health, communicable diseases, HIV/AIDS and other health conditions.
As otherwise permitted in our Notice of Health Information Privacy Practices and by applicable law.
By clicking “I agree”, you agree to let us share your records as described above and acknowledge receipt of the Notice of Health Information Privacy Practices. Dissemination of any patient identifiable images or information from the telehealth visit to researchers or other educational entities will not occur without your affirmative consent.
SMS and Email Communications
By providing your phone number and email, you consent to receive from Arima Provider Group and Arima promotional and marketing texts, other text messages, and emails related to our products and services such as appointment reminders and notifications. You understand SMS text messages and emails are not always secure because they travel over networks that we do not control, messaging frequency may vary, and SMS message and data rates may apply. This consent is not required for you to receive our products and services.
You may ask us to stop sending you marketing texts at any time by contacting us at contact@arimahealth.com or clicking the unsubscribe link (where available) in one of our messages.
Agreement and Consent
If you have questions about any of the contents of this Agreement, our procedures, or your role in this process, please discuss them with your Care Team. Remember that the best way to assure quality treatment is to keep communication open and direct with your clinician(s).
By clicking “I accept”, you indicate that you have read and understood this document, and that you agree to abide by its terms. Further, you certify that if you are signing as a personal representative of the Member, you have legal authority to provide consent for the treatment of the Member.
Additional State-Specific Notifications:
Alaska: You understand your primary care provider may obtain a copy of your records of your telehealth encounter. (Alaska Stat. § 08.64.364).
Arizona: You understand that all medical records resulting from a telemedicine consultation are part of your medical record. (A.R.S. § 12-2291.)
Colorado: If you want to register a formal complaint about a provider, you should file at: https://dpo.colorado.gov/FileComplaint.
Connecticut: You understand your primary care provider may obtain a copy of your records of your telehealth encounter, and that you can revoke your consent at any time. (Conn. Gen. Stat. Ann. § 19a-906).
D.C.: You have been informed of alternate forms of communication between you and a physician for urgent matters. (D.C. Mun. Regs. tit. 17, § 4618.10).
Georgia: You have been given clear, appropriate, accurate instructions on follow-up in the event of needed emergent care related to the treatment. (Ga. Comp. R. & Regs. 360-3-.07(7)).
Iowa: If you want to register a formal complaint about a provider, visit: https://medicalboard.iowa.gov/consumers/filing-complaint.
Idaho: If you want to register a formal complaint about a provider, visit: https://dopl.idaho.gov/filing-a-complaint/.
Illinois: If you want to register a formal complaint about a provider, visit: https://idfpr.illinois.gov/admin/dpr/complaint.html.
Indiana: If you want to register a formal complaint about a provider, visit: https://inoag.my.salesforce-sites.com/ConsumerComplaintForm.
Kansas: If you have a primary care provider or other treating physician, the person providing telemedicine services must send within three business days a report to such primary care or other treating physician of the treatment and services rendered during the encounter. (Kan. Stat. Ann. § 40-2,212(2)(d)(2)(A)). Complaint process: http://www.ksbha.org/complaints.shtml.
Kentucky: If you want to register a formal complaint about a provider, visit: https://kbml.ky.gov/grievances/Pages/default.aspx.
Louisiana: You understand the role of other health care providers who may be present during the consultation other than the telehealth provider. (46 La. Admin. Code Pt XLV, § 7511).
Maine: If you want to register a formal complaint about a provider, visit: https://www.maine.gov/md/complaint/file-complaint.
Maryland: Telehealth services may not be provided based solely on an online questionnaire. Complaint form: https://www.mbp.state.md.us/forms/complaint.pdf.
Nebraska: All confidentiality protections apply to the telehealth consultation. You may access medical information resulting from the telehealth consultation as provided by law. No dissemination of identifiable images or information is permitted without written consent. You may request an in-person consult immediately after the telehealth consult and will be informed if one is unavailable. Complaint process: https://dhhs.ne.gov/Pages/Complaints.aspx.
New Hampshire: You understand the telehealth provider may forward your medical records to your primary care or treating provider. (N.H. Rev. Stat. § 329:1-d).
New Jersey: You have the right to request a copy of your medical information and understand it may be forwarded directly to your primary care provider or other provider of record. (N.J. Rev. Stat. Ann. § 45:1-62).
Ohio: You understand the telehealth provider may forward your medical records to your primary care or treating provider. (Ohio Admin. Code 4731-11-09(C)).
Oklahoma: Complaint resources: http://www.okmedicalboard.org/complaint and https://www.ok.gov/osboe/faqs.html.
Rhode Island: You understand the permitted types of transmissions, when alternate communication or office visits should be used, security measures, and potential risks to privacy. (Rhode Island Medical Board Guidelines).
South Carolina: You understand your medical records may be distributed in accordance with applicable law to other treating health care practitioners. (S.C. Code Ann. § 40-47-37).
South Dakota: You received disclosures regarding delivery models, treatment methods or limitations, and discussed diagnosis and risks/benefits of treatment options. (S.D. Codified Laws § 34-52-3).
Texas: You understand your medical records may be sent to your primary care physician. (Tex. Occ. Code Ann. § 111.005). You have been informed of the following notice:
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.
Utah: You understand fee disclosures, information rights, emergency limitations, privacy risks, and security standards. You may access, supplement, amend, request copies, and request transfer of your telemedicine medical record. (Utah Admin. Code r. 156-1-603).
Virginia: You acknowledge receipt of required security and privacy disclosures and provide consent to forward identifiable information to a third party. (Virginia Board of Medicine Guidance Document 85-12).
Vermont: You understand you have the right to receive a consult with a distant-site provider and may request one immediately or within a reasonable time. Complaint process: http://www.healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint.
This document describes what you can expect and your rights as a patient of Arima Provider Group. The following walks you through our services and clinical programs, and how they will benefit and impact you.
General Information
Sleep Clinics of America, P.C., Sleep Clinics of Oregon, P.C., Sleep Clinics of Kansas, P.C., Sleep Medicine Clinic of America New York, P.C., Sleep Clinics of California, P.C. (collectively, “Arima Provider Group”, “we”, “our” or “us”) provides technology-enabled sleep healthcare services via telehealth through its engaged clinicians and support staff (the “Care Team”) with non-clinical support from its technology partner, Arima Health Technology, Inc. (“Arima”). Arima does not provide clinical services; it performs administrative, payment, and other supportive activities for Arima Provider Group. When you request to receive services from an Arima Provider Group clinician, those services are outlined by this Telehealth Consent and Practice Policies Agreement (this “Agreement”), as well as the discussions between you and your clinician(s). It is important for you to read this document and discuss any questions you might have with your Arima Provider Group care team. If you agree to these terms, we will assume that you have read, understood, and agree to the contents of this Agreement.
Our Services and Technology
When you become a patient of Arima Provider Group (a “Member”), you will be given access our online platform (the “Platform”) and our Care Team. The Platform provides personalized content and interactive resources for you, and connects you to our Care Team. Your Care Team will be with you every step of the way and work collectively to support high quality, effective care. For purposes of this Agreement, “you” means you as the patient, or as the lawful guardian, conservator, or custodian on behalf of your family member (“Family Member”) to the extent you are signing this Agreement on behalf of a Family Member.
You are entitled to receive information from your Care Team about the methods of treatment, the credentials of members of your Care Team, the techniques used, the duration of your treatment (if known), and the fee structure. You may terminate treatment at any time.
Responsibility for your overall medical care should remain with your local primary care doctor, if you have one, and we strongly encourage you to locate one if you do not have a primary care doctor.
Company may use artificial intelligence programs to assist with patient intake, charting, scheduling, and other administrative or support tasks. You understand that while the artificial intelligence program may provide informational content, it will not provide medical or clinical advice and is not a licensed clinical provider. If you are seeking medical or clinical advice, please reach out to an Arima Medical Group clinician or your primary care provider.
Telehealth Informed Consent - Risks and Benefits
Your Care team will provide sleep health services via telehealth using video calls, voice calls, and asynchronous messaging services. They may prescribe you medication or recommend other treatment, as needed.
PLEASE NOTE: OUR CARE TEAM DOES NOT ADDRESS EMERGENCIES VIA TELEHEALTH. IF YOU ARE EXPERIENCING SUICIDAL OR HOMICIDAL THOUGHTS OR CONSIDERING HARMING YOURSELF OR OTHERS, IMMEDIATELY DIAL 9-8-8 FOR THE NATIONAL SUICIDE AND CRISIS PREVENTION HOTLINE OR DIAL 9-1-1 FOR EMERGENCY SERVICES. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY OR ARE OTHERWISE IN IMMINENT DANGER, IMMEDIATELY DIAL 9-1-1 AND/OR GO TO THE NEAREST EMERGENCY ROOM.
You will have an opportunity to develop ongoing care relationships with your Arima Provider Group clinician(s), however, your initial encounter may begin as a consultation (e.g. to determine the most appropriate treatment setting for you to receive care) and will not necessarily give rise to an ongoing treatment relationship. In that case, the Care Team will work with you to identify the appropriate care.
Telehealth will involve electronic communication of your personal medical information to other health practitioners who may be located in other areas, including out of state. All laws and protections for in-person medical visits also apply to telehealth visits. This includes confidentiality of information, access to medical records, and sharing of information that could identify you personally.
You have a right to know who is attending each telehealth visit. You may decide that you do not want to use telehealth services at any time. This will not make you lose your health program benefits or your rights to future health care.
Telehealth may offer benefits such as improved access to care, convenience, and more efficient evaluation and management, including access to specialty expertise as appropriate. However, as with any health service, there are potential risks associated with using technology. These risks include service problems and delays in evaluation or treatment due to technology or internet failures, not having enough information to make health care decisions, rare security errors, and other risks. You understand that the Care Team relies on you to provide accurate information and that we are not responsible for issues resulting from errors and omissions in the relay of this information.
If you need to receive follow-up care, assistance in the event of an adverse reaction to the treatment, or in the event of an inability to communicate as a result of a technological or equipment failure, please contact Arima Provider Group through the patient portal or via email at contact@arimahealth.com.
Telehealth may not be appropriate for all conditions and treatments. We can provide assistance to find in-person care if we determine telehealth is not clinically appropriate.
Payment and Billing
You understand that if your health insurance (including Medicare) coverage does not cover the charges for your services in full or at all, you may be fully or partially responsible for payment. If your health insurance requires you to pay a deductible, copayment or coinsurance for your healthcare, the usual cost-sharing rules will apply. Please check with your health plan to determine if any services will be reimbursed. If you request, we will work with you to determine what your charges will be. If you are paying for your visit without insurance, we will inform you of any amounts owed.
You agree that Medicare, health plans and any other persons or organization (third parties) who pay any part of your Arima Provider Group bill are authorized to pay these amounts directly to us (instead of you). You agree that we may submit claims to these third parties on your behalf. You understand that you must pay us for services we provide that are not paid by your insurance or other third parties (“Your Costs”), unless state or federal regulations do not allow this.
By providing us with your credit card information and associated billing information, you are authorizing us to save on file and charge your credit card for agreed upon purchases and your continued use of the services (e.g. Your Costs including any copayments, deductibles and co-insurance, etc. for any and all visits with us) with no additional consent required by you. If your health plan or another third party has arranged with us to pay the fee or any portion of the fee, or if the fee is pursuant to some other arrangement with us, that fee adjustment will be reflected in the fee that you are ultimately charged.
Scheduling and Attendance
We understand you may have to reschedule or cancel an appointment from time to time. We ask that you notify us at least 24 hours in advance of your scheduled appointment. If you do not notify us at least 24 hours in advance, we will charge you a $50 cancellation fee. If you repeatedly miss scheduled appointments and we are unable to contact you for a significant period of time, you understand that you may be terminated from the practice and will no longer be considered a patient of Arima Provider Group.
Other Acknowledgements
Arima Provider Group will rely on all information you provide as accurate and complete. You understand that Arima Provider Group will use such information in its delivery of the Services to you. The inaccuracy of any such information you provide to Arima Provider Group may impact the efficiency and accuracy of the Services.
Arima Provider Group will provide you with information related to your diagnosis, treatment and ongoing care. The success of your treatment is dependent on your review of this information, and you agree to review all such information.
Some parts of the Services may require obtaining tests at a testing facility or lab that are not owned or controlled by Arima Provider Group (e.g., labs, bloodwork, sleep test).
It is Arima Provider Group’s policy to report, in accordance with applicable law, any disclosures that may cause a reasonable suspicion of abuse or neglect of a person belonging to a vulnerable population.
There is a risk of technical failures during the telehealth encounter beyond the control of Arima Provider Group. You agree to hold harmless Arima Provider Group for delays in evaluation or for information lost due to such technical failures that are beyond Arima Provider Group’s reasonable control.
Complaint Policy
You have the right to communicate grievances regarding your care. Should you wish to make a formal complaint about one of your care providers you may do so in writing and submit the concern to us at:
Attn: Arima Health
contact@arimahealth.com
If you wish to submit a complaint about your clinician, you can contact Arima Provider Group for information on how to submit a complaint to the relevant state licensure board.
Access To Records
You have the right to request a copy of your medical records. You can request to obtain or send a copy of your medical records to your primary care or other designated health care provider by contacting us at:
Attn: Arima Health
contact@arimahealth.com
A copy will be provided to you at reasonable cost of preparation, shipping and delivery.
Privacy Practices
We follow federal healthcare privacy and security laws and protect your health information. We work hard to make sure that your personal information is secure. We use standard physical, electronic, and business security methods to help prevent access to your health information by people who should not see it. But we cannot promise that data sent over the Internet or through a data storage facility will be perfectly secure. So, although we try to protect your personal information, we cannot guarantee the security of any information you send to us. You can read more information about our use of health information and other personal information in our Notice of Health Information Privacy Practices (“NPP”).
By clicking “I agree”, you agree that we may share your health records and healthcare information with the following individuals under the following circumstances without further notice to you while you are a Member of Arima Provider Group:
With your other healthcare providers (including your primary care provider), either directly or through our participation in health information exchanges, for healthcare coordination, payment, operations and treatment purposes. This may include information relating to genetic tests, substance or alcohol use, mental health, communicable diseases, HIV/AIDS and other health conditions. You understand that in most instances we will send such records to your primary care provider after each visit.
With other individuals involved in your care such as caregivers or family members.
With your health plan, either directly or through our participation in health information exchanges, for healthcare payment, coordination, operations and treatment purposes (such as eligibility verification, processing your claims, and audits of our services). This may include information relating to genetic testing, substance or alcohol use, mental health, communicable diseases, HIV/AIDS and other health conditions.
As otherwise permitted in our Notice of Health Information Privacy Practices and by applicable law.
By clicking “I agree”, you agree to let us share your records as described above and acknowledge receipt of the Notice of Health Information Privacy Practices. Dissemination of any patient identifiable images or information from the telehealth visit to researchers or other educational entities will not occur without your affirmative consent.
SMS and Email Communications
By providing your phone number and email, you consent to receive from Arima Provider Group and Arima promotional and marketing texts, other text messages, and emails related to our products and services such as appointment reminders and notifications. You understand SMS text messages and emails are not always secure because they travel over networks that we do not control, messaging frequency may vary, and SMS message and data rates may apply. This consent is not required for you to receive our products and services.
You may ask us to stop sending you marketing texts at any time by contacting us at contact@arimahealth.com or clicking the unsubscribe link (where available) in one of our messages.
Agreement and Consent
If you have questions about any of the contents of this Agreement, our procedures, or your role in this process, please discuss them with your Care Team. Remember that the best way to assure quality treatment is to keep communication open and direct with your clinician(s).
By clicking “I accept”, you indicate that you have read and understood this document, and that you agree to abide by its terms. Further, you certify that if you are signing as a personal representative of the Member, you have legal authority to provide consent for the treatment of the Member.
Additional State-Specific Notifications:
Alaska: You understand your primary care provider may obtain a copy of your records of your telehealth encounter. (Alaska Stat. § 08.64.364).
Arizona: You understand that all medical records resulting from a telemedicine consultation are part of your medical record. (A.R.S. § 12-2291.)
Colorado: If you want to register a formal complaint about a provider, you should file at: https://dpo.colorado.gov/FileComplaint.
Connecticut: You understand your primary care provider may obtain a copy of your records of your telehealth encounter, and that you can revoke your consent at any time. (Conn. Gen. Stat. Ann. § 19a-906).
D.C.: You have been informed of alternate forms of communication between you and a physician for urgent matters. (D.C. Mun. Regs. tit. 17, § 4618.10).
Georgia: You have been given clear, appropriate, accurate instructions on follow-up in the event of needed emergent care related to the treatment. (Ga. Comp. R. & Regs. 360-3-.07(7)).
Iowa: If you want to register a formal complaint about a provider, visit: https://medicalboard.iowa.gov/consumers/filing-complaint.
Idaho: If you want to register a formal complaint about a provider, visit: https://dopl.idaho.gov/filing-a-complaint/.
Illinois: If you want to register a formal complaint about a provider, visit: https://idfpr.illinois.gov/admin/dpr/complaint.html.
Indiana: If you want to register a formal complaint about a provider, visit: https://inoag.my.salesforce-sites.com/ConsumerComplaintForm.
Kansas: If you have a primary care provider or other treating physician, the person providing telemedicine services must send within three business days a report to such primary care or other treating physician of the treatment and services rendered during the encounter. (Kan. Stat. Ann. § 40-2,212(2)(d)(2)(A)). Complaint process: http://www.ksbha.org/complaints.shtml.
Kentucky: If you want to register a formal complaint about a provider, visit: https://kbml.ky.gov/grievances/Pages/default.aspx.
Louisiana: You understand the role of other health care providers who may be present during the consultation other than the telehealth provider. (46 La. Admin. Code Pt XLV, § 7511).
Maine: If you want to register a formal complaint about a provider, visit: https://www.maine.gov/md/complaint/file-complaint.
Maryland: Telehealth services may not be provided based solely on an online questionnaire. Complaint form: https://www.mbp.state.md.us/forms/complaint.pdf.
Nebraska: All confidentiality protections apply to the telehealth consultation. You may access medical information resulting from the telehealth consultation as provided by law. No dissemination of identifiable images or information is permitted without written consent. You may request an in-person consult immediately after the telehealth consult and will be informed if one is unavailable. Complaint process: https://dhhs.ne.gov/Pages/Complaints.aspx.
New Hampshire: You understand the telehealth provider may forward your medical records to your primary care or treating provider. (N.H. Rev. Stat. § 329:1-d).
New Jersey: You have the right to request a copy of your medical information and understand it may be forwarded directly to your primary care provider or other provider of record. (N.J. Rev. Stat. Ann. § 45:1-62).
Ohio: You understand the telehealth provider may forward your medical records to your primary care or treating provider. (Ohio Admin. Code 4731-11-09(C)).
Oklahoma: Complaint resources: http://www.okmedicalboard.org/complaint and https://www.ok.gov/osboe/faqs.html.
Rhode Island: You understand the permitted types of transmissions, when alternate communication or office visits should be used, security measures, and potential risks to privacy. (Rhode Island Medical Board Guidelines).
South Carolina: You understand your medical records may be distributed in accordance with applicable law to other treating health care practitioners. (S.C. Code Ann. § 40-47-37).
South Dakota: You received disclosures regarding delivery models, treatment methods or limitations, and discussed diagnosis and risks/benefits of treatment options. (S.D. Codified Laws § 34-52-3).
Texas: You understand your medical records may be sent to your primary care physician. (Tex. Occ. Code Ann. § 111.005). You have been informed of the following notice:
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.
Utah: You understand fee disclosures, information rights, emergency limitations, privacy risks, and security standards. You may access, supplement, amend, request copies, and request transfer of your telemedicine medical record. (Utah Admin. Code r. 156-1-603).
Virginia: You acknowledge receipt of required security and privacy disclosures and provide consent to forward identifiable information to a third party. (Virginia Board of Medicine Guidance Document 85-12).
Vermont: You understand you have the right to receive a consult with a distant-site provider and may request one immediately or within a reasonable time. Complaint process: http://www.healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint.
Sleep Well. Live Better.
Contact information
Address: 169 Madison Avenue,
Suite 1137. New York, NY 10016
Patient Support
Call Us: 804-269-8291
Sign up for email updates
Stay in touch with us. We'd love to do the same!
© 2026 Arima Health. All rights reserved.
Sleep Well. Live Better.
Contact information
Address: 169 Madison Avenue, Suite 1137. New York, NY 10016
Patient Support
Call Us: 804-269-8291
Sign up for email updates
Stay in touch with us. We'd love to do the same!
© 2026 Arima Health. All rights reserved.
Sleep Well. Live Better.
Contact information
Address: 169 Madison Avenue, Suite 1137. New York, NY 10016
Patient Support
Call Us: 804-269-8291
Sign up for email updates
Stay in touch with us. We'd love to do the same!
© 2026 Arima Health. All rights reserved.
Sleep Well. Live Better.
Contact information
Address: 169 Madison Avenue, Suite 1137.
New York, NY 10016
Patient Support
Call Us: 804-269-8291
Sign up for email updates
Stay in touch with us. We'd love to do the same!
© 2026 Arima Health. All rights reserved.