Telehealth Informed Consent

1. Nature of telehealth

My Fit-RX LLC, a Nevada limited liability company, doing business as MyFit-Rx ("MyFit-Rx," "we," "us"), connects patients with independent licensed providers through a third-party telehealth partner. Telehealth is the delivery of healthcare services using electronic communications when the patient and provider are not in the same location. Through our telehealth partner, independent licensed providers affiliated with [MEDICAL GROUP NAME] evaluate you remotely using the information you provide through the partner's secure platform.

MyFit-Rx itself does not provide medical care. Your evaluation and any treatment occur on the partner platform.

2. Benefits and risks

Benefits of telehealth include convenient access to licensed providers, no travel, and faster evaluation.

Risks and limitations include the inability to perform a physical examination, possible technical failures, delays caused by incomplete information, and the possibility that telehealth is not appropriate for your condition — in which case the provider may direct you to in-person care.

3. Provider discretion

The licensed provider alone determines whether telehealth is appropriate for you and whether any treatment or prescription is clinically appropriate. Completing an evaluation does not guarantee a prescription. Prescriptions are issued only when clinically appropriate.

4. Your right to decline or withdraw

You may decline telehealth services or withdraw your consent at any time, before or during your evaluation, without affecting your right to seek care elsewhere.

5. Your health records

Your health information is collected and maintained by the treating providers and dispensing pharmacy, including [PHARMACY NAME]. You can access your records through the partner's patient portal after completing intake, subject to applicable law.

6. Privacy

Health information you provide on the partner platform is protected under the providers' and pharmacy's own privacy practices and Notices of Privacy Practices. MyFit-Rx does not receive or store your intake answers or medical history.

7. Not for emergencies

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

8. Identity and location verification

You will be asked to verify your identity and the state you are located in at the time of your evaluation. Providers can only treat patients located in states where they are licensed. Providing false identity or location information may result in denial of service.

9. Compounded medications

Some treatments offered through the platform involve compounded medications. Compounded medications are not FDA-approved. They are prepared by licensed pharmacies, including [PHARMACY NAME], pursuant to a prescription from a licensed provider.

10. Questions

Questions about the telehealth experience may be sent to admin@myfit-rx.com. Clinical questions should be directed to your provider through the patient portal.