Dialogue Consent Form

Last Updated: December 17 2021

The purpose of this consent form is to obtain your consent for Dialogue to provide you with various healthcare, mental health, and Orientation and Counselling services. This includes your consent to care via Telemedicine, or to Orientation and Counselling services on various subjects as described below. You must read and be sure that you fully understand this consent form, the Terms of Use, and the Privacy Policy before using Dialogue’s secure platform (the “Platform), made available through Dialogue’s application for mobile devices and through a web browser (the “App”). If you have any questions, please contact us at hello@dialogue.co. If you want to withdraw your consent, you can stop using the Platform at any time.

Telemedicine:

Telemedicine refers to healthcare services provided at a distance using information and communications technologies, such as chat, messaging, interactive audio and video technology. The Platform allows users to access healthcare services via on-demand Telemedicine consultations.

Orientation and Counselling services:

Orientation and Counselling services refer to the services provided by Dialogue that are not medical and that, such as legal or financial services, work and career advisory services, family, marital and relationships advisory services and other children and elder care services.

About Telemedicine Consultations:

During a Telemedicine consultation on the Platform, you and the Regulated Health Professional will discuss your medical history, your symptoms, and any tests or treatment that you may require. The Regulated Health Professional may use the communication and interactive features of the Platform to assess your condition, and may prescribe medication to you, order tests, or refer you to another healthcare provider for in-person examination, treatment or follow-up care. The Platform is not intended to replace your existing healthcare providers, such as your family doctor.

Risks and Limitations:

Telemedicine is convenient and promotes access to healthcare services. However, there are certain limitations and potential risks associated with Telemedicine.

About the Risks and Limitations of Telemedicine:

• Telemedicine is dependent on broadband infrastructure and consultations are susceptible to degradation or loss of connection.

• Not all health conditions can be adequately assessed through Telemedicine due to technological limitations.

• A Regulated Health Professional may not have access to your up-to-date medical records, which may result in an inaccurate assessment and/or treatment plan.

• Dialogue will use all reasonable means to protect the security and confidentiality of information sent and received during the Consultation. However, despite our efforts to protect the privacy and security of electronic communications, it is not possible to completely secure the information and thus there is no guarantee against data breaches, which may result in the unauthorized collection, use and/or disclosure of your personal health information.

• Do not use the Platform for medical emergencies. If you have a medical emergency you must contact emergency services in your area by dialing 911 or go to the nearest hospital or healthcare center.

About Orientation and Counselling Consultations

During Orientation and Counselling Consultations on the Platform, you and the relevant professional, counsellor or advisor, as the case may be, will discuss information about your personal life, such as your family, relationship, legal, financial or career situation. The professional, counsellor or advisor, as the case may be, may use the communication and interactive features of the Platform or external video or audio communications software to assist you. He or she may also refer you to other professionals, organizations or resources for in-person consultations or follow-up requests. The Platform is not intended to replace your existing and usual counsels, if any.

Governing Law and Jurisdiction

Governing Law

You agree that:

1) All aspects of the relationship between you and a Regulated Healthcare Professional or any other Dialogue professional, counsellor or advisor, (as well as her/his agents, delegates, and any physicians and other independent healthcare practitioners providing medical or other healthcare and treatment to you or in association with Dialogue), including without limitation any medical or other healthcare and treatment provided to you, and

2) the resolution of any and all disputes arising from or in connection with that relationship, including any disputes arising under or in connection with this Agreement,

shall be governed by and construed in accordance with the laws of the province or territory where you are located at the time of your consultation with a Regulated Health Profressional or any other Dialogue professional, counsellor or advisor, (other than conflict of laws rules) and the laws of Canada applicable therein.

Exclusive Jurisdiction

You hereby acknowledge that (i) the medical or other healthcare and treatment services as well as the other professional services that you receive from a Regulated Health Professional or any other Dialogue professional(s), counsellor(s) will be provided in the province or territory where you are located at the time you receive that medical or other healthcare and treatment services, as well as the other professional services, and that (ii) the Courts of the province or territory where you are located at the time any Telemedicine or Orientation and Counselling services is provided to you shall have exclusive jurisdiction to hear any complaint, demand, claim, proceeding or cause of action, whatsoever arising from or in connection with that medical or other healthcare and treatment or the advices received, or from any other aspect of the relationship between you and a Regulated Health Professional or any other Dialogue professional, counsellor or advisor.

Consent

By clicking or pressing the "I Agree" button, I indicate that:

• I understand and acknowledge the risks and limitations of Telemedicine and the Platform, including the technological limitations of Telemedicine and the risk of data breaches.

• I understand and acknowledge that I must not use the Platform for medical emergencies.

• I understand and consent to the collection, use and sharing of my personal information and personal health information in accordance with the Privacy Policy, including that:

  • Dialogue will collect my personal information and personal health information in order to schedule consultations and provide me with access to Telemedicine and Orientation and Counselling services;

  • Dialogue will never disclose my personal health information to a third-party without my express consent, except when the disclosure or assistance plan is part of a care or assistance plan that I have agreed to, in which case the agreed care or assistance plan will constitute implied consent for disclosure to other professionals or organizations;

  • Dialogue will safeguard my information using integrated physical, administrative and technological safeguards and encrypt all consultations end-to-end; and

  • My personal information, including personal health information, will be de-identified and anonymized before being analyzed and may be used by Dialogue for product development and research purposes;

  • Dialogue can share, with selected third-parties or me, demographic and contact information about me (including but not limited to: name, DOB and any email addresses or phone numbers) by email, SMS, instant messaging or any other means necessary for reasons including, but not limited to, verifying my identity, medical follow-up, scheduling appointments, confirming appointments, customer support and technical support.

  • Electronic communications with members of the Dialogue care team may be copied or transcribed in full and made part of my medical records.

• In the event that I raise a concern to Dialogue (by way of email to Dialogue, by completing a Net Promoter Score (NPS) feedback survey that raises concern with the quality of care I received, or by raising a concern with my organization's administrator) related to the services I have received from a Regulated Health Professional or any other Dialogue professional, counsellor or advisor, I understand, acknowledge and consent to the following:

• Dialogue's Clinical Quality team conducting an internal investigation into my concern in order to understand what could have been done to serve me better;

• Dialogue's Customer Success team communicating with me via email in order to seek my permission to be contacted (via my account) by the Clinical Quality team during and/or after their internal investigation process (i.e. to discuss my concern), if determined to be necessary by the Clinical Quality team;

• That my involvement in the internal investigation process is optional and that I may refuse and/or withdraw my consent to be contacted during the investigation at any time, by way of email;

• That in order to investigate my concern, Dialogue's Clinical Quality team may have access to my medical records and, if so, will limit their review to the minimal amount of information required in order to investigate on a strictly need-to-know basis;

• That in order to investigate my concern, Dialogue's Clinical Quality team may need to seek support of other non-healthcare professionals at Dialogue, such as Customer Success or Engineering, to investigate factors that may have contributed to my issue or concern; and

• That all members of Dialogue's team involved in the investigation process have entered into and are subject to confidentiality agreements, that Dialogue has implemented appropriate access controls and procedures to safeguard sensitive personal health information, and that any information accessed or shared will be on a data-minimized, need-to-know basis.

• I understand and acknowledge that any feedback that I provide to Dialogue shall become the exclusive property of Dialogue and I agree that Dialogue will be free to use the feedback for any purpose.

• I have read and understand this consent form and consent to care via Telemedicine and to virtual counselling using the Platform.