Medical Consent & Telehealth Agreement

I. GENERAL CONSENT

• Wellness Lab RX provides access to care through licensed providers.
• Wellness Lab RX is a platform and coordination service, not a direct provider of medical care.
• All clinical decisions are made by independent licensed providers.

By using this platform, you consent to:

• Evaluation
• Communication
• Treatment planning
• Prescription coordination (if appropriate)

II. TELEHEALTH CONSENT

What Telehealth Is

• Remote care via video, messaging, or digital intake.
• No guarantee of prescription or treatment.

Expected Benefits

• Increased access to care
• Convenience
• Faster coordination
• Ongoing support

Risks

• Technology failures
• Delays in care
• Incomplete information
• Privacy/security risks
• Potential for clinical limitations

Patient Acknowledgment

User agrees:

• Telehealth has limitations.
• Results are not guaranteed.
• They can withdraw consent anytime.
• They are responsible for providing accurate information.

III. HIPAA + PRIVACY CONSENT

HIPAA Compliance Statement

Wellness Lab RX follows applicable privacy laws and safeguards.

Information may be shared with:

• Providers
• Pharmacies
• Labs
• Payment processors

ONLY as needed for care, operations, and coordination.

Communications Consent

You agree to receive:

• SMS
• Email
• Appointment reminders
• Clinical updates

Vendor Disclosure

Wellness Lab RX may use third-party systems for:

• Payments
• Scheduling
• Messaging
• Data storage

These vendors are required to maintain confidentiality.

IV. FINANCIAL CONSENT

You agree:

• Payment is required for services.
• Card may be kept on file.
• Charges may occur for services rendered.
• Programs may be auto-renewing.
• You must cancel BEFORE billing cycle.
• No refunds unless explicitly stated.

You authorize Wellness Lab RX to:

• Charge your card for services.
• Process recurring payments.
• Adjust invoices if needed.

V. PRESCRIPTION + PHARMACY DISCLOSURE

• Prescriptions are issued ONLY if medically appropriate.
• Providers are independent.
• Pharmacy fulfillment is separate.

Approved pharmacies may include:

• Grand Avenue
• Optimal Balance
• Lake Hills
• Strive
• Signature

Wellness Lab RX does NOT guarantee:

• Prescription approval
• Medication availability
• Specific pharmacy fulfillment

VI. SHIPPING AUTHORIZATION

You understand:

• Medication is considered fulfilled once shipped.
• Shipping delays are outside company control.
• Address accuracy is your responsibility.

You agree:

• Wellness Lab RX may ship medication to provided address.
• You accept risk of carrier delays.

VII. NO GUARANTEES

Results vary from person to person.

Wellness Lab RX does not guarantee:

• Weight loss outcomes
• Hormone optimization results
• Clinical improvements

VIII. USER ACKNOWLEDGMENT

By using this platform, you confirm:

• You have read and understood this consent.
• You agree to telehealth services.
• You accept financial terms.
• You authorize communication and coordination.

Continued use of the platform constitutes acceptance of these terms. For information regarding patient rights and safety in weight-loss programs, please review our Weight-Loss Consumer Bill of Rights.

IX. CONTACT

Wellness Lab RX
support@wellnesslab-rx.com
https://wellnesslab-rx.com