Telehealth Consent
Last updated: April 29, 2025
BY CLICKING “I AGREE,” CHECKING A RELATED BOX TO SIGNIFY YOUR ACCEPTANCE, USING ANY OTHER ACCEPTANCE PROTOCOL PRESENTED THROUGH THE SERVICE, OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, YOU ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND AGREED TO BE BOUND BY THIS CONSENT. IF YOU DO NOT AGREE, DO NOT USE THE SERVICE.
Emergency Care Disclaimer
IF YOU HAVE A MEDICAL EMERGENCY, SEEK IN-PERSON EMERGENCY CARE IMMEDIATELY OR DIAL 911.
Purpose
This Telehealth Consent (“Consent”) outlines the nature, benefits, and risks of receiving medical care through telehealth by Rejuvaris Hormone & Urgent Care Center (“Rejuvaris”). Telehealth services may be provided by physicians, physician assistants, and nurse practitioners (“Providers”) via secure digital communication systems.
Use of Telehealth
Telehealth involves the remote delivery of healthcare via video, audio, messaging, or electronic data exchange when a patient and Provider are not in the same location. It may include:
- Transmission of health data, images, or medical records
- Video or audio consultations
- Provider review of lab tests and diagnostic images
You may opt for in-person care at any time and are encouraged to discuss care options with your Provider.
Benefits
- Convenient and timely access to care
- Flexible scheduling
- Safe access from home or remote locations
Risks & Limitations
- Potential limitations in diagnosis due to lack of physical examination
- Technical failures or errors
- Unauthorized access to data despite security measures
- Incomplete access to medical history could affect treatment decisions
- Telehealth may not be appropriate for all conditions
Laboratory & At-Home Testing
You may be asked to complete lab tests or at-home kits. These are processed by third-party laboratories. Rejuvaris and Providers are not responsible for false positives/negatives or testing malfunctions that may impact diagnosis or treatment.
Data Privacy & Security
Rejuvaris uses secure systems to protect your information. Health data will not be shared without your consent, except as required by law or outlined in the Provider’s Notice of Privacy Practices.
Follow-Up & Emergencies
In the event of technical failure, please contact: 1-800-REJUVARIS (M–F, 9AM–5PM ET). For emergencies, call 911. Telehealth is not suitable for urgent or life-threatening conditions.
Your Acknowledgments
By using our Service, you acknowledge:
- Telehealth services may involve beta or evolving technologies
- Diagnosis and treatment via telehealth may be limited
- No specific outcomes can be guaranteed
- You are responsible for providing accurate health information
- Providers may determine telehealth is not appropriate and refer you elsewhere
- You consent to electronic communication of your personal and medical information
- You are responsible for all fees and will not seek reimbursement from Medicare or similar programs
- You may withdraw consent in writing, but services may be discontinued as Rejuvaris does not offer in-person care
Texas Residents
To file a complaint against a physician or other licensee with the Texas Medical Board:
Texas Medical Board – Investigations
333 Guadalupe, Tower 3, Suite 610
P.O. Box 2018, MC-263
Austin, TX 78768-2018
Phone: 1-800-201-9353
Website: www.tmb.state.tx.us
Insurance & Payment
You agree that if an insurance company mistakenly reimburses you directly for services provided by Rejuvaris, you authorize us to charge your payment method on file for the same amount unless alternative payment is provided within 3 days of receipt.
By continuing to use the Rejuvaris platform, you confirm your agreement with the contents of this Telehealth Consent.