3.1 The Patient agrees to participate actively in the treatment process, which includes attending scheduled appointments, cooperating with the treatment plan, and communicating honestly.

3.2 The Patient understands that they have a right to be informed about their treatment, including potential risks and benefits, and agree to ask questions if they need clarification.

3.3 The Patient agrees to inform the Clinician of any other ongoing mental health treatment or medication they are receiving.

3.4 Late, Missed Appointment and Cancellation Policies: If you arrive too late to allow time for proper care, you may be asked to reschedule. Late arrivals and missed appointments prevent you from receiving required care and prevent the clinician from providing that care. Missed appointments also prevent another person from receiving care during that time. You will be financially responsible for the cancellation fee (refer to financial policy for cancellation fee schedule).

3.5 Medication Refill Policy: If you need a medication refill, please email support@savantcare.com with your full name, name of the medication and dose. We receive multiple automated requests each day from pharmacies, so please allow 5 business days to process your request. If it is an urgent request, please mention so in the email and we will prioritize it. Controlled substances will not be prescribed or refilled without an appointment with your clinician.

3.6 Controlled Medication Policy: All Savant Care patients and staff are required to follow the strict policies and laws outlined by the Drug Enforcement Agency related to the prescribing of controlled medications.

Types of controlled medications can be found here: https://www.dea.gov/drug-information/drug-scheduling. Always take extra precautions when handling a prescription or controlled medication such as patches, stimulants, sedative-hypnotic agents etc. We reserve the right to refuse to give early refills or to replace lost prescriptions. If abuse or misuse of any mental health medicine is suspected, we may discontinue care and recommend that you seek treatment elsewhere. It is your responsibility to notify your clinician of all prescription and over the counter medications that you take. There is any evidence that you have received controlled prescriptions without informing your Savant Care clinician, we reserve the right to discharge from the clinic immediately. Presenting late for appointments, canceling appointments when important compliance issues need to be discussed or calling for refills after missed/canceled appointments may be construed as non-compliance and you may be discharged from clinic in these instances. In such cases, if you are concerned for your health or safety, you should visit the nearest emergency room or call 911.

3.7 Shared and Collaborative Care: At Savant Care, we value collaborative care. Patients with mental health concerns, in our opinion, do best when monitored by a team that might include a psychiatrist or psychiatric nurse practitioner, a therapist and a primary care physician. To make this collaborative care model a reality, we use the following standards:

3.7.1 All Savant Care patients are encouraged to meet regularly with their primary care physician. Your Savant Care psychiatrist or nurse practitioner will regularly update your primary care physician on any changes to your condition or your treatment plan. Your primary care physician is also invited to attend any of your appointments at Savant Care (usually best accomplished through Telehealth).

3.7.2 Your Savant Care psychiatrist or nurse practitioner will give you advice on mental health medication options. Psychiatrists are medical doctors that have extensive training in both physical and mental health so that they can see the big picture of what treatments will best fit your overall health needs. Psychiatric nurse practitioners are nurses who have completed additional training which allows them to assess mental health problems and prescribe medications and nurse practitioner can oversee your medication treatment over time to make sure it is going smoothly.

Please note that Savant Care physicians and nurse practitioners are licensed to practice in your home state of residence and they cannot prescribe any medications to any pharmacy outside of your home state of residence.

3.7.3 If your psychiatrist or nurse practitioner thinks you need to see a mental health therapist for counselling, they will try to find a Savant Care mental health professional who can meet with you. Your psychiatrist, nurse practitioner and mental health therapist will collaborate regularly and provide supervision to your therapist about your case to make sure the treatment continues according to plan so that you meet your mental health goals. We rely on our therapists company for therapy appointments and to schedule them by working with your Savant Care psychiatrist. If your insurance company does not pay the co-signed rates, you will be responsible to negotiate with your insurance provider.

As noted by the American Medical Association, during the COVID-19 pandemic, telehealth emerged as a vital way to maintain patient access to high-quality care. Most Savant Care clinical appointments are now offered via telehealth. If you do not wish to be seen via telehealth, we can arrange for you to see a clinician in a traditional office setting; please note that there is limited availability for in-office appointments.

3.8.1 Potential risks of telehealth: As with any medical procedure, there may be potential risks associated with the use of Telepsychiatry. These risks include, but may not be limited to:

3.8.1.1 Information transmitted may not be sufficient (e.g., poor resolution of video) to allow for appropriate decision-making by your clinician.

3.8.1.2 Your clinician may not be able to provide medical treatment using interactive electronic equipment nor provide for or arrange for emergency care that you may require.

3.8.1.3 Delays in medical evaluation and treatment may occur due to deficiencies or failures of the equipment.

3.8.1.4 Security protocols can fail, causing a breach of privacy of confidential health information.

3.8.1.5 A lack of access to all the information that might be available in a face to face visit, but not in a Telepsychiatry session, may result in errors in judgment.

3.8.2 Patient's Rights Related to the use of Telehealth

3.8.2.1 I understand that the laws that protect the privacy and confidentiality of medical information also apply to Telepsychiatry.

3.8.2.2 I have the right to withhold or withdraw my consent to the use of Telepsychiatry during the course of my care at any time. I understand that my withdrawal of consent will not affect any future care or treatment

3.8.2.3 I have the right to inspect all medical information that includes the Telepsychiatry visit. I may obtain copies of this medical record information for a reasonable fee.

3.8.2.4 I understand that my clinician has the right to withhold or withdraw consent for the use of Telepsychiatry during the course of my care at any time

3.8.2.5 I understand that the laws that protect the privacy and confidentiality of medical information also apply to Telepsychiatry

3.8.2.6 I understand that the all rules and regulations that apply to the provision of healthcare services in the State of California also apply to Telepsychiatry

3.8.3 Patient's Responsibilities to the use of Telepsychiatry

3.8.3.1 I will not record any Telepsychiatry sessions without written consent from my clinician.

3.8.3.1 I will inform my clinician if any other person can hear or see any part of our session before the session begins. The clinician will inform me if any other person can hear or see any part of our session before the session begins

3.8.3.2 I understand that I, not my clinician, am responsible for the configuration of any electronic equipment used on my computer that is used for Telepsychiatry. I understand that it is my responsibility to ensure the proper functioning of all electronic equipment before my session begins.

3.8.3.3 I understand that I must be a resident of the State in which I receive the service and be physically present in my state of residence to be eligible for Telepsychiatry services from my clinician

3.8.3.4 I understand that my initial evaluation will not be done by Telepsychiatry except in special circumstances under which I will be required to verify my identity

3.8.3.5 I understand that there are strict rules related to telehealth and controlled medications and that my telehealth clinician reserves the right to decline my request for any controlled medications

3.8.4 Patient Consent to the use of Telepsychiatry: I have read and understand the information provided above regarding Telepsychiatry. I have discussed it with my clinician and all of my questions have been answered to my satisfaction. I hereby give my informed consent for the use of Telepsychiatry in my health care and authorize my clinician to use Telepsychiatry in the course of my diagnosis and treatment.

As of May 15, 2023, Savant Care has been providing medical care using augmented intelligence (also known as artificial intelligence or AI). This HIPAA compliant service uses a computer program (called an eNotetaker) to take notes during your appointment with the clinician. During your appointment, the eNotetaker will listen to and record what you and your clinician talk about, and then convert that information into a written note in your medical chart. Since the clinician doesn't have to take any notes, he or she can give you the full attention that you need during your visit. The eNotetaker collects only the information we need to help you.

Your Personal Health Information (PHI) never leaves our secure servers. All recordings and notes from your appointment are accessible only by Savant Care staff. As required by State law, your information will be retained for a specified period of time (usually 7 years in California); after that, your information will be permanently deleted.

If you prefer to see a doctor who does not use the eNotetaker, please let us know and we will transfer your care to a clinician who does not use augmented intelligence charting. Please review the Savant Care Privacy Policy for additional information.

4.1 The Clinician will provide professional and competent care, in line with current professional standards. Please note that your Savant Care clinician is licensed to prescribe only in your state of legal residence.

4.2 The Clinician will respect the rights and privacy of the Patient, in line with legal and ethical guidelines.

4.3 The Clinician will keep the Patient informed about their treatment progress and any changes in the treatment plan.

4.4 The Initial Consultation: All appropriate intake paperwork must be completed prior to your first appointment. The first appointment usually lasts for 50 minutes. During the first session, the Savant Care clinician will obtain a comprehensive history and determine whether our clinic can meet your treatment needs. This session is also an opportunity for both you and the clinician to assess your mutual compatibility for an ongoing treatment relationship. Depending on the complexity of your case, a second consultation appointment may be required to complete the assessment, determine treatment fit and/or make treatment recommendations. Medications may or may not be prescribed during the initial appointment.

4.5 Paperwork policy: Clinicians at Savant Care do not perform medicolegal or non-treating psychiatric assessments. We respectfully decline to see clients who only seek completion of their paperwork (disability paperwork, FMLA etc) at the initial consultation or within 3 months of the initial consultation. Our clinicians might help you with supportive paperwork only after establishing care with the patient over a period of 3-6 months. The clinician will charge you separately for any paperwork they complete based on the time spent to complete that paperwork. Charges for paperwork are out of pocket and completely the patient's responsibility. To know about the charges please refer to the FAQ section at https://www.savantcare.com/faq#paperwork-cost

4.6 Savant Care staff do not accept gifts from patients. Savant Care staff do not participate in business deals with patients.

5.1 Both parties understand that all information shared during the course of treatment is confidential, except as required by law or as agreed upon in writing.

5.2 Exceptions to confidentiality include situations involving imminent danger to self or others, cases of child or elder abuse, or when court-ordered. If you are a danger to yourself or others or if a clinician suspects abuse towards a child, disabled adult or the elderly, the clinician is ethically and legally required to report it to the appropriate authorities.

5.3 Privacy: Savant Care operates in accordance with the HIPAA laws. The HIPAA Privacy Rule allows covered health care providers to share protected health information without your authorization. For example, HIPAA does not require your written consent for a doctor to receive your lab tests, or for your primary care doctor and specialist to discuss your case. The HIPAA Privacy Rule also allows for health care providers to disclose protected health information to business associates such as insurance companies. Savant Care will not disclose details of your treatment or your medical record to non-HIPAA third parties without your written approval.

5.4 Email and SMS Communication: Email and SMS texting are a popular and convenient way to communicate. This is why, in their latest modification to the HIPAA, the Department of Health and Human Services states that if a patient has been made aware of the risks of unencrypted email/SMS, and if that same patient provides consent to receive health information such as appointment reminders, appointment confirmation or requests for medication refills etc via email/SMS, then a health entity may send that patient personal medical information via unencrypted email/SMS. Since Savant Care will use email and text messages to communicate with the patient. By consenting to the use of email and texting with Savant Care, you agree to the following:

ACKNOWLEDGMENT and AGREEMENT: Savant Care will use reasonable means to protect the privacy of the patient's health information. However, because of the risks outlined above, Savant Care cannot guarantee that e-mail will be confidential. Additionally, Savant Care will not be liable in the event that you or anyone else inappropriately uses or accesses your e-mail. Savant Care will not be liable for improper disclosure of your health information that is not caused by Savant Care's intentional misconduct.

Patient agreement: By signing this form, I acknowledge that I understand the risks associated with the communications of e-mail between Savant Care and me, and consent to the conditions outlined herein, as well as any other instructions that Savant Care may provide to communicate with me by e-mail. Any questions I may have had were answered. I understand that this consent is valid until I revoke the consent as outlined above, except to the extent that a person who is to make a communication has already acted in reliance upon this authorization.

6.1 The Patient agrees to pay for services at the agreed-upon rate, and to provide payment at the time of each appointment unless another arrangement has been made in writing. Credit card information and/or bank information will be obtained prior to your first appointment at Savant Care. You and/or your payer will be charged before each appointment with your Savant Care clinician according to the fee structure outlined in the Financial Policies. If you have insurance, Savant Care will charge you the appropriate coinsurance or copayment as derived from your insurance company's eligibility database. If after charging for the copayment or coinsurance, Savant Care comes to know through your insurance's Explanation of Benefits that the amount due is greater or less than the amount originally charged to you, Savant Care will appropriately bill you for the difference and/or refund the excess to your patient account as applicable. Neither Savant Care nor its' clinicians are liable for any copay, coinsurance, or other obligations reported to our office by your insurance company. Should you have questions regarding your coverage, please contact your insurance carrier for details. If you seek reimbursement from an insurer, Savant Care can submit claims on your behalf at your request (see Financial Policies for further information).

6.2 The Patient agrees to pay for missed appointments and cancellations without 24 hours' notice, as detailed in the Financial Policies.

7.1 Both the Patient and the Clinician have the right to terminate treatment at any time. The Clinician may provide recommendations for other clinicians if treatment is terminated.

7.2 As a last resort, Savant Care reserves to discharge patients from the clinic under the various conditions including but not limited to:

• Multiple missed appointments or late cancellations. If we have not heard from you for more than 6 months, or if you have missed or cancelled more than three appointments in 12 months, we will close your file and advise that you seek services from a more suitable clinic.
• Complete disregard of the treatment plan.
• Breach of trust in the clinician-patient relationship.
• Evidence of misuse or diversion of any DEA-controlled medication.
• Threatening or abusive behavior towards any Savant Care staff.
• Non-payment of fee owed to Savant Care.

We respect the rights of individuals to voice their opinions on our clinicians and services. However, since we will protect your privacy by never answering any reviews that you might post on social media, we ask that you contact our office at support@savantcare.com to voice any concerns or issues you are facing so we can seek to resolve any conflicts. If you are not satisfied with Savant Care's internal findings, you may request an arbitration of the matter pursuant to the arbitration clause below.

Arbitration: TO THE EXTENT NOT PROHIBITED BY APPLICABLE LAW THAT CANNOT BE WAIVED, THE PARTIES (YOU AND SAVANT CARE) HEREBY WAIVE, AND COVENANT THAT THEY WILL NOT ASSERT (WHETHER AS PLAINTIFF, DEFENDANT OR OTHERWISE), ANY RIGHT TO TRIAL BY JURY IN ANY ACTION ARISING IN WHOLE OR IN PART UNDER OR IN CONNECTION WITH THIS AGREEMENT OR ANY OF THE CONTEMPLATED TRANSACTIONS, WHETHER NOW EXISTING OR HEREAFTER ARISING, AND WHETHER SOUNDING IN CONTRACT, TORT OR OTHERWISE. THE PARTIES AGREE THAT ANY OF THEM MAY FILE A COPY OF THIS PARAGRAPH WITH ANY COURT AS WRITTEN EVIDENCE OF THE KNOWING, VOLUNTARY AND BARGAINED-FOR AGREEMENT AMONG THE PARTIES IRREVOCABLY TO WAIVE ITS RIGHT TO TRIAL BY JURY IN ANY PROCEEDING WHATSOEVER BETWEEN THEM RELATING TO THIS AGREEMENT OR ANY OF THE CONTEMPLATED TRANSACTIONS AND THAT ANY SUCH PROCEEDING WILL INSTEAD BE SETTLED BY BINDING ARBITRATION ADMINISTERED BY THE AMERICAN ARBITRATION ASSOCIATION IN ACCORDANCE WITH ITS COMMERCIAL ARBITRATION RULES [INCLUDING THE OPTIONAL RULES FOR EMERGENCY MEASURES OR PROTECTION]. THE ARBITRATION HEARING SHALL TAKE PLACE IN SANTA CLARA COUNTY, CALIFORNIA, OR WITHIN A 50 MILE RADIUS OF THE CLINIC WHERE SERVICES WERE RENDERED, BEFORE A SINGLE ARBITRATOR. JUDGMENT ON THE AWARD RENDERED BY THE ARBITRATOR MAY BE ENTERED IN ANY COURT HAVING JURISDICTION THEREOF.

Before arbitration results are finalized, the patient agrees not to post any reviews, accusations, or inflammatory postings online. The arbitration clause is important to allow an independent review of the matter.

1. Medical doctors are licensed and regulated by the Medical Board of California, (800) 633-2322, www.mbc.ca.gov

2. The Department of Consumer Affairs' Board of Psychology receives and responds to questions and complaints regarding the practice of psychology. If you have questions or complaints you may contact the Board on the Internet at www.psychology.ca.gov, by e-mailing bopmail@dca.ca.gov, calling 1-866-503-3221 or writing to the following address: Board of Psychology 1625 North Market Blvd, Suite N-215 Sacramento, CA 95834

3. Medical doctors are licensed and regulated by the Medical Board of California. To check up on a license or to file a complaint go to www.mbc.ca.gov , email licensecheck@mbc.ca.gov, or call (800) 633-2322

Your signature is considered binding and in agreement with full understanding of the above points.

By signing below, the Patient acknowledges that they have read and understood the terms of this Contract, and agree to abide by its terms during their treatment. The Patient also acknowledges that they have had the opportunity to ask questions and discuss this Contract with Savant Care Clinician.

This contract is subject to change with appropriate notice, and does not guarantee a particular outcome. The undersigned agree that this contract represents the complete understanding between the Patient and the Savant Care Clinician.