Telehealth Informed Consent

1. What is Telehealth?

Telehealth (also called telemedicine) involves the use of electronic communications such as video conferencing, secure messaging, and phone calls to enable healthcare providers to evaluate, diagnose, and treat patients at a distance.

2. How Telehealth Works at AgeReverse-RX

Our telehealth services typically include:

• An online medical questionnaire to collect your health history
• A remote consultation with a licensed clinician via secure video, phone, or asynchronous messaging
• Review of your medical information, diagnosis, and treatment recommendations
• Electronic prescribing of medications when clinically appropriate
• Follow-up visits and ongoing monitoring

3. Possible Benefits of Telehealth

• Convenience: Access care from your home
• Increased access to providers
• Continuity of care through easier follow-ups
• Reduced exposure by avoiding travel and waiting rooms

4. Possible Risks and Limitations

• Technical issues such as internet or video interruptions may disrupt care
• Providers cannot perform hands-on physical examinations
• Incomplete or inaccurate information may affect diagnosis or treatment
• Although we use secure systems, there is a small risk of unauthorized access to electronic communications

5. Alternatives to Telehealth

You have the right to receive care in person. If your clinician determines that an in-person evaluation is necessary, we will provide guidance on how to access appropriate care.

6. Your Responsibilities

• Provide accurate and complete health information
• Use a private location during telehealth visits to protect your confidentiality
• Ensure you have a stable internet connection
• Inform your provider immediately if you experience a medical emergency
• Follow medical instructions and attend follow-up visits

7. Emergencies

Telehealth is not appropriate for medical emergencies. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately.

8. Provider Responsibilities

• Conduct evaluations based on the information you provide
• Determine whether telehealth is appropriate
• Refer you to in-person care when necessary
• Protect your health information in accordance with HIPAA

9. Consent

By proceeding with telehealth services, you acknowledge that:

• You have read and understand this Telehealth Consent
• You understand the benefits, risks, and alternatives
• You voluntarily agree to receive telehealth services
• You may withdraw consent at any time

10. Contact Information

AgeReverse-RX

[email protected]

Email: [email protected]

Phone: (Phone number coming soon — see contact page for current options)