Informed Consent Documents

What telehealth is

Telehealth means your clinician evaluates and treats you using live video, audio, secure messaging, and the information you provide, instead of an in-person office visit.

Your visit will be conducted by a clinician licensed in the state where you are physically located at the time of the visit. If you travel to a state where we are not licensed, we cannot see you there.

What telehealth cannot do

Your clinician cannot physically examine you. They cannot listen to your heart or lungs, palpate your abdomen, perform a pelvic or prostate exam, or take your blood pressure themselves. Some conditions cannot be safely diagnosed or treated without those things.

If your clinician determines that you need an in-person examination, imaging, a procedure, or hands-on care, they will tell you and help you arrange it. Declining that referral may mean we cannot continue to treat the condition.

Telehealth is NOT emergency care. If you are having a medical emergency, call 911 or go to the nearest emergency department. If you are in a mental health crisis, call or text 988.

Risks of telehealth

Information transmitted may be insufficient for the clinician to make a decision, which may result in a delay in diagnosis or treatment.

Technology may fail during the visit, requiring rescheduling.

In rare cases, a security breach could expose your health information despite the safeguards we maintain.

A clinician who cannot examine you may miss something that an in-person examination would have found.

Your rights

You may withhold or withdraw this consent at any time, without affecting your right to future care or treatment.

You may request an in-person referral at any time.

You have the right to access your medical record, and to receive an electronic copy of it.

Your clinician may also decide that telehealth is not appropriate for you and end the telehealth relationship.

Recording

We do not record video visits. We document the encounter in a written chart note that becomes part of your medical record.

You may not record a visit without the clinician's consent; several states in which we operate require the consent of all parties.

Where you are located

You must tell us truthfully what state you are physically in at the start of every visit. This determines which laws apply and which clinician may legally treat you. Providing false location information may make your treatment unlawful and will end the relationship.

Acknowledgment

I acknowledge that I have been provided with, and had the opportunity to read, the Notice of Privacy Practices describing how my health information may be used and disclosed and how I can get access to it.

I understand I may request a paper copy at any time at no charge.

We do not accept insurance

We are a cash-pay practice. We do not bill Medicare, Medicaid, TRICARE, or any commercial insurance plan. We are not enrolled as a participating provider with any plan.

Because we do not bill your insurer, we also do not submit claims on your behalf, and we cannot guarantee that any amount you pay us will count toward your deductible. You may submit our itemized superbill to your insurer yourself; whether they reimburse you is entirely between you and them.

If you are a Medicare beneficiary, note that we do not bill Medicare for any service. Discuss with us if you have questions about how this affects you.

Your Good Faith Estimate

Because you are self-pay, federal law entitles you to a written Good Faith Estimate of expected charges before you receive care. We provide one automatically before your first visit and whenever your plan of care changes materially.

If you are billed at least $400 more than your Good Faith Estimate, you may start a patient–provider dispute resolution process. Using it will not affect your care.

What the membership fee covers

Your membership covers clinical services: visits, messaging, care planning, and prescribing. It is a fee for professional services.

It does NOT cover medication. You buy medication from a pharmacy of your choosing at that pharmacy's price. We have no ownership interest in any pharmacy and receive no payment from any pharmacy, laboratory, or drug manufacturer.

It does NOT cover laboratory testing, which is billed by an independent laboratory.

Automatic renewal and cancellation

Membership renews automatically each month at the price shown at signup, charged to the payment method on file, until you cancel.

You may cancel at any time from your account page in two clicks, or by emailing us. Cancellation takes effect at the end of the current paid period. There are no cancellation fees and no minimum term.

We will email you before any price change, with enough notice to cancel first.

Stopping payment does not by itself end the clinical relationship, and it does not make it safe to stop medication abruptly. Tell your clinician.

Refunds

If you are found ineligible for treatment at or before your first visit, you receive a full refund.

Unused whole months are refunded on request. The month in which you received care is not refunded.

Secure portal is the default

All clinical communication happens inside the secure patient portal. We will not discuss your care by ordinary email or SMS unless you specifically ask us to and accept the risks.

Email and text message

Ordinary email and SMS are NOT secure. Messages can be intercepted, misdelivered, or read by anyone with access to your device or account.

If you consent, we may send appointment reminders, refill reminders, and notices that a new message is waiting for you. These will contain the minimum information necessary.

Message and data rates may apply. Reply STOP to opt out of text messages at any time; reply HELP for help. Opting out of text messages will not affect your care.

Consent to marketing messages is separate, is never required to receive care, and can be withdrawn at any time.

What is being prescribed and why

Semaglutide and tirzepatide are injectable medications that mimic gut hormones (GLP-1, and for tirzepatide also GIP). They reduce appetite, slow stomach emptying, and improve blood sugar control.

Wegovy® and Zepbound® are FDA-approved for chronic weight management. Ozempic® and Mounjaro® are FDA-approved for type 2 diabetes. If your clinician prescribes Ozempic® or Mounjaro® for weight management, that is an OFF-LABEL use — legal and common, but not an FDA-approved indication for that specific product. Your clinician will tell you which product and which indication applies to you.

Wegovy®, Ozempic® (Novo Nordisk A/S), Zepbound®, and Mounjaro® (Eli Lilly and Company) are registered trademarks of their respective owners. We are not affiliated with, endorsed by, or sponsored by these manufacturers.

Compounded medications

We prescribe FDA-approved, manufacturer-produced medications. We do not prescribe compounded semaglutide or compounded tirzepatide.

Compounded versions of these drugs are not FDA-approved, are not reviewed for safety, effectiveness, or quality, and have been associated with dosing errors and adverse events. The FDA-declared shortages that previously permitted broad compounding of these molecules have ended.

Boxed warning — thyroid tumors

In studies, these medications caused thyroid C-cell tumors in rats and mice. It is not known whether they cause medullary thyroid carcinoma (MTC) in humans.

You must NOT take these medications if you or any family member has had medullary thyroid carcinoma, or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Tell your clinician immediately about a lump or swelling in the neck, hoarseness, trouble swallowing, or shortness of breath.

Common side effects

Nausea, vomiting, diarrhea, constipation, abdominal pain, heartburn, burping, fatigue, and injection-site reactions. These are most common when starting and when increasing the dose, and usually improve with time.

We escalate your dose slowly, and we will hold the dose if side effects are hard to tolerate. Tell us — do not just stop.

Serious risks

Pancreatitis (inflammation of the pancreas): severe stomach pain that may spread to your back, with or without vomiting. Stop the medication and seek care immediately.

Gallbladder disease, including gallstones sometimes requiring surgery. Rapid weight loss increases this risk.

Kidney injury from dehydration due to vomiting or diarrhea.

Low blood sugar, especially if you also take insulin or a sulfonylurea. Your other medications may need to be adjusted.

Worsening of diabetic eye disease (retinopathy) when blood sugar improves rapidly.

Allergic reactions, including anaphylaxis and angioedema.

Delayed stomach emptying, which can affect anesthesia. Tell any surgeon or anesthesiologist that you take this medication.

Reports of suicidal thoughts have been investigated; regulators have not established a causal link, but we screen you for depression at baseline and at each review, and you should report any new or worsening mood changes.

Loss of muscle and bone

A meaningful fraction of weight lost on these medications is lean mass, not only fat. We ask you to eat adequate protein and perform resistance training. This is part of the treatment, not an optional extra.

Pregnancy and contraception

Do not take these medications if you are pregnant, trying to become pregnant, or breastfeeding. Weight loss during pregnancy can harm a developing fetus.

Stop semaglutide at least 2 months before a planned pregnancy because it stays in your body for a long time.

These medications may reduce the effectiveness of oral contraceptives around the time of dose changes. Discuss backup contraception with your clinician.

What happens when you stop

Obesity is a chronic disease. Studies consistently show that most people regain a substantial portion of lost weight after stopping. This is a physiologic response, not a personal failure.

Treatment is intended to be long-term. Discuss any plan to stop with your clinician so we can support you.

Alternatives

Alternatives include structured lifestyle and behavioral programs alone, other FDA-approved anti-obesity medications, metabolic and bariatric surgery, and no treatment. Your clinician will discuss these with you.

No guarantee

No specific amount of weight loss is promised or guaranteed. Individual results vary. Any before-and-after images or testimonials we publish represent individual experiences, not typical results.