Telehealth Weight-Loss Informed Consent
Please read carefully. By signing below, you acknowledge and consent to telehealth-based evaluation and weight-loss care.
Telehealth Consent
Telehealth uses electronic communication (video, phone, secure messaging) for evaluation, education, and treatment planning. Telehealth has limitations compared with an in-person visit.
- You will provide accurate information and a reliable way to contact you.
- You confirm you will be physically located in a state where the clinician is licensed at the time services are provided.
- Technical issues may interrupt care and may require rescheduling or alternative communication methods when appropriate.
Clinical Decision-Making
Treatment is individualized. Medication is not guaranteed. Your clinician may recommend lifestyle changes, labs, in-person evaluation, or referral based on safety and clinical judgment.
- You agree to provide complete and truthful medical history, medications, and supplements.
- You understand that eligibility depends on clinical criteria, contraindications, and monitoring.
Risks & Side Effects
Weight-loss treatment may include nutrition/activity counseling and may include prescription medication when appropriate. All medications carry risks and possible side effects; results vary and are not guaranteed.
- Side effects can include GI upset, headache, fatigue, dizziness, constipation/diarrhea, and other medication-specific effects.
- Rare but serious complications may occur depending on the medication/class and your health history.
Pregnancy, Breastfeeding, Contraindications
You agree to disclose pregnancy status, breastfeeding, trying-to-conceive plans, and relevant medical conditions, as many weight-loss medications are not appropriate during pregnancy/breastfeeding.
- You will notify the clinic promptly if you become pregnant or suspect pregnancy.
- You will disclose relevant conditions/history and all medications/supplements.
Monitoring & Follow-Up
Safe care may require current vitals (weight, blood pressure, heart rate), labs, and follow-up visits. You agree to complete requested monitoring within the timeframe provided.
- Not completing monitoring may delay care or limit ongoing treatment.
Compounding Pharmacy
If medication is prescribed, it may be fulfilled by a licensed compounding pharmacy. Compounded preparations are customized and may differ from commercially manufactured products.
- Pharmacy pricing, shipping, and timelines are determined by the pharmacy and may change.
- Pharmacy charges are typically separate from clinical service fees unless explicitly included.
- You agree to follow storage, handling, and administration instructions provided by the pharmacy and clinician.
Privacy & Communication
We use reasonable safeguards to protect health information, but electronic communication has inherent risks. You consent to communications for scheduling, onboarding, and care coordination.
- You will keep your login credentials private and use secure devices when possible.