Developer Terms

Appendix, Inc. ("Appendix") operates a telemedicine service in which licensed physicians review clinical requests and, where clinically appropriate, issue prescriptions. When your application submits a request through the Prescribing API, Appendix is the medical practice. Your application introduces its user to Appendix and passes along their request; the care relationship is formed directly between Appendix and the patient at the consent step. You are not a party to it, you do not direct it, and these terms do not make you a provider of medical services.

You are responsible for everything done with your API keys. Test keys (ak_test_…) are sandbox-only: simulated decisions, no physician, no charge. Production keys (ak_live_…) reach a real physician and are issued only after we approve your production request. Keep keys secret; rotate any key you believe is compromised. You must provide accurate company, app, and contact information and keep it current — it is shown to patients on the consent screen.

The sandbox is a development tool, nothing more. It is provided as is, solely for building and testing your integration. Using a test key does not create a business relationship between you and Appendix, and because no physician ever reviews a sandbox request, no physician-patient relationship is formed with anyone. Sandbox responses are simulated and must never be presented to a real person as medical advice or a prescription.

In your use of the API, you must not:

• present physician review as a formality, guarantee a prescription, or advertise a specific clinical outcome;
• submit requests for a person without their knowledge, fabricate or alter the clinical information a person provides, or coach users to misrepresent symptoms;
• attempt to access the patient's care record, physician messages, or identity-verification materials — including by asking the patient to share credentials or magic links;
• place personal health information (defined in section 4) in external_id or any other field we document as free of it;
• use the API for controlled substances or for any condition or medication outside the categories Appendix publishes;
• resell, sublicense, or proxy API access to third parties without a separate written agreement with us.

"Personal health information" means information that identifies, or could reasonably identify, a person — such as name, contact details, date of birth, government identifiers, or precise location — combined with, or revealing, information about that person's health, symptoms, care, prescriptions, or payment for care.

By design, the API returns you no personal health information — only a neutral projection: status, your own external_id, prescription count, and a message doorbell. You agree not to attempt to re-identify clinical details from it. Whatever intake information you collect from your users before calling the API is governed by your own privacy policy and applicable law — you represent that you have the right to pass that intake to Appendix for the purpose of a clinical review, and that you disclose this to your users.

Production reviews are billed from your prepaid credit balance at the rates published on the pricing page at the time the review completes — or at the rates established by a separate written agreement between you and Appendix, where one exists: a complete-review fee when the physician finishes the review (prescription, advice, or order), and a smaller incomplete-review fee when the physician reviews the request but must redirect the patient elsewhere. Nothing is charged at submission or consent. Credit purchases and auto-refill top-ups are charged to your card on file. Credits are not transferable; contact us about unused balances if you close your account. We may change published pricing prospectively with notice.

We may suspend your production access immediately if we believe your integration endangers patients, violates these terms, or breaks the law — patient safety overrides commercial considerations, always. We will tell you why and work with you on reinstatement where possible. You may stop using the API at any time. Sections 4, 7, and 8 survive termination.

The API is provided "as is" without warranties of uptime or fitness. Clinical decisions are made independently by licensed physicians; we make no promise about the outcome of any individual review. To the maximum extent permitted by law, Appendix's total liability to you under these terms is limited to the amounts you paid us in the twelve months before the claim, and neither party is liable for indirect or consequential damages.

You will indemnify Appendix against third-party claims arising from your application, your marketing, or your breach of these terms — including claims that you misrepresented the service to your users.

We may update these terms with at least 3 days' notice to the email on your developer account; continued production use after the effective date constitutes acceptance of the new version. The version you accepted is recorded on your account.

If you and Appendix enter into a separate written agreement covering your use of the API — for example, negotiated terms or pricing for your specific use case — that agreement controls wherever it conflicts with these terms.