Template — must be reviewed by qualified counsel before launch. This is placeholder language drafted for development only. It is not legal advice and has not been validated against the telehealth, prescribing, and consent laws of any state. A licensed healthcare attorney must review and finalize this document before any patient relies on it.
1. What telehealth is
Telehealth is the delivery of healthcare using secure technology — online intake forms, messaging, and, where appropriate, audio or video — to connect you with a licensed physician without an in-person visit. At US Peptides Rx, telehealth is how a physician reviews your health information and determines whether a peptide therapy is clinically appropriate for you.
Telehealth is voluntary. By completing your medical intake and submitting it for review, you consent to be evaluated remotely by a licensed physician. You may withdraw this consent at any time before a therapy is dispensed, though doing so may mean a physician cannot complete an evaluation.
2. The physician evaluation
Every order is doctor-gated. A U.S.-licensed physician reviews the information you provide — your goals, medical history, current medications, and relevant disclosures — and uses clinical judgment to decide whether to prescribe a therapy, request more information, or decline. The physician's decision is independent and is not directed by sales goals.
A therapy is provided only where it is clinically appropriate and legally permitted in your state. The physician may determine that a therapy is not suitable for you, may recommend an alternative, or may advise that you seek in-person care.
3. Your responsibilities
The quality of a remote evaluation depends on the accuracy and completeness of what you share. You agree to provide truthful, current, and complete health information, to disclose all medications, supplements, allergies, and relevant conditions, and to follow the guidance your care team provides. Withholding information can make a therapy unsafe.
You agree that you are the person completing the intake, that you are of legal age in your state, and that the contact and shipping details you provide are your own.
4. Benefits and limitations
Telehealth can make physician-supervised care more convenient, more private, and more accessible. It also has limits. A remote physician cannot perform a physical examination, and certain situations require in-person evaluation, laboratory testing, or imaging that telehealth cannot provide.
Telehealth is not a substitute for emergency care. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Do not use this service to seek urgent or emergency treatment.
5. No guarantee of outcome
Submitting an intake does not guarantee that a therapy will be prescribed, and no therapy is guaranteed to produce a particular result. Peptide therapies are used to support specific goals where clinically appropriate; individual responses vary. The physician makes no promise of a cure, of disease prevention, or of any specific outcome.
6. Risks of telehealth
As with any care, telehealth carries risks. These can include, without limitation: a remote evaluation reaching a conclusion that an in-person visit might not; delays or interruptions caused by technology; and, despite reasonable safeguards, the rare possibility of a security event affecting electronic information. Any therapy also carries its own potential side effects, which your physician will discuss with you where a therapy is prescribed.
7. Privacy of your health information
The health information you share is handled with confidentiality and reasonable administrative, technical, and physical safeguards. We do not sell your personal health information. How we collect, use, and protect your information is described in our Privacy Policy.
8. If a physician declines — no charge
If a physician determines that a therapy is not the right fit for you, you are not charged for that therapy. Any amount collected at the time of order for a declined therapy is refunded. We would rather decline a sale than ship something a physician has not approved — your safety comes before a transaction.
9. Consent
By submitting your intake, you acknowledge that you have read and understood this consent, that you have had the opportunity to ask questions, and that you voluntarily consent to a telehealth evaluation by a licensed physician through US Peptides Rx. You understand you may decline or discontinue telehealth at any time without affecting your right to seek care elsewhere.
10. Questions
If you have questions about telehealth care or this consent, contact our care team before submitting your intake. We are happy to walk you through any part of the process.
Ready when you are
Your evaluation begins with a short, secure intake. A licensed physician takes it from there — and you are never charged for a therapy a physician declines.