Telehealth Consent Agreement 

Madison Meds Telehealth Consent Agreement

You have requested Madison Meds to connect you with a licensed physician (“Physician”) who will review the health details you provide through our online telehealth platform (the “Service”). The Physician will determine whether any Madison Meds weight loss products or services are medically suitable for you (the “Physician Consultation”). This Consent form explains telehealth services and obtains your permission to receive care via telehealth through Madison Meds.

The terms “you” and “your” refer to the individual using the Service, or if the user is a minor (ages 13–18 or older if state law requires), the parent or legal guardian providing consent on their behalf.

Please read this carefully. By selecting “I Agree,” proceeding with the Physician Consultation, or otherwise using the Service, you confirm that you understand and accept the following terms:

1. What is Telehealth?
   Telehealth means delivering healthcare services remotely through electronic communication, such as phone calls, video chats, messaging, or electronic transfer of medical records. This allows diagnosis, treatment, prescribing, education, and follow-up care without needing to be in the same location as the Physician.
2. Benefits of Telehealth

• Easier access to healthcare services
• Ability to receive care at convenient times and locations
• More efficient management of your health needs

3. Potential Risks of Telehealth

• The inability to conduct a physical examination may limit the Physician’s ability to fully evaluate your condition
• Technical problems, including software or hardware failures, may affect the quality or timeliness of care
• Privacy risks may arise from electronic transmission of your health information despite security measures
• Loss or unauthorized disclosure of your personal health data is possible, though Madison Meds takes steps to protect your information

4. Consent to Telehealth Services
   By using this Service, you agree to receive healthcare via telehealth. The Physician may decide at any time that telehealth is not appropriate for your care and may discontinue your telehealth services. If this occurs, you agree to stop using the telehealth Service immediately.
5. Right to Withdraw Consent
   You may revoke your consent to receive telehealth care by notifying Madison Meds in writing. This revocation takes effect once received but does not affect any care provided before the revocation. Please note Madison Meds and its Physicians do not offer in-person services; therefore, withdrawal means telehealth care will end.
6. Emergency Situations
   This Service is not intended for emergency medical or mental health care. In case of a medical emergency, call 911. If you are experiencing a mental health crisis or suicidal thoughts, contact the Suicide and Crisis Lifeline at 988.
7. Protection of Your Information
   Madison Meds and its Physicians use appropriate technology and protocols to safeguard your health information under HIPAA. However, complete security cannot be guaranteed for the electronic systems you use to access the Service. Communications containing protected health information may be sent via phone, email, or other electronic means.
8. No Guarantee of Prescription or Results
   Use of the Service does not guarantee that a prescription will be provided or that any specific health outcomes will be achieved.
9. Accuracy of Your Information
   You agree to provide truthful and complete health information. Inaccurate or incomplete details may negatively affect your care. The Physician will rely solely on the information you provide during your consultation.
10. Payment Terms
    Payments you make cover the telehealth Service, Physician Consultation, and any medications prescribed. Madison Meds and Physicians do not bill insurance or third parties on your behalf.
11. Responsibility for Follow-Up Care
    You are responsible for arranging and paying for any follow-up treatments beyond the telehealth Service.
12. Medication Dispensing and Delivery
    If prescribed, your medication will be sent to a Madison Meds affiliated pharmacy for fulfillment and shipped to the address you provide. Please ensure your delivery address is accurate and secure.
13. Sharing of Health Information
    By consenting, you authorize Madison Meds and its Physicians to share your protected health information with pharmacies and other entities involved in your care, as detailed in our Privacy Policy.
14. Accessing Your Medical Records
    You may request copies of your medical records related to this Service by contacting Madison Meds in accordance with applicable laws.
15. Filing Complaints

• For issues regarding Physicians, contact your state medical board.
• For concerns about pharmacies, contact your state pharmacy board. Madison Meds provides relevant contact information on our website.

By clicking “I Agree” or continuing to use the Service, you acknowledge that you have read, understood, and accept this Telehealth Consent Agreement.

Questions or Concerns?

We welcome your feedback and questions about your privacy. Please contact us at:

Madison Meds
Email: ask@madisonmeds.com