Telehealth Informed Consent

Effective date: July 6, 2026 · beBIONIC · Lutz, FL · (813) 563-2799

By checking the consent box on our intake form and typing your name, you acknowledge and agree to the following.

1. What telehealth is

Telehealth is the delivery of health care using electronic communications. Your care may be provided asynchronously ("store-and-forward" — a licensed provider reviews the information, photos, and history you submit and responds without a live visit) and/or by live video or phone when your provider determines it is needed. Your care is provided by a physician-supervised care team of licensed providers.

2. Benefits and risks

• Benefits: convenient access to care, no travel or waiting rooms, timely provider review.
• Risks: your provider does not perform a hands-on physical exam and relies on the information you provide; delays or failures of electronic equipment or connectivity can occur; in rare cases, security protocols could fail and cause a privacy breach; a lack of access to your complete medical records could result in adverse drug interactions, allergic reactions, or other errors — which is why complete, truthful answers are essential.

3. Your responsibilities

• Provide truthful, accurate, and complete information about your health, medications, and allergies, and update us if anything changes during treatment.
• Follow your provider's instructions, including dosing, storage, and any lab or follow-up requirements.
• Stop treatment and contact us — or seek emergency care — if you experience serious side effects.

4. Medications, including compounded medications

• Your provider may prescribe medications, including compounded medications prepared by independent, state-licensed compounding pharmacies. Compounded medications are permitted under federal law but are not FDA-approved, and the FDA does not verify their safety, effectiveness, or quality before dispensing.
• GLP-1 medications (e.g., semaglutide, tirzepatide) have known risks including nausea, vomiting, diarrhea, constipation, injection-site reactions, gallbladder disease, pancreatitis, kidney injury from dehydration, and hypoglycemia (especially with diabetes medications). GLP-1 medications carry a boxed warning regarding thyroid C-cell tumors observed in rodents; they should not be used with a personal or family history of medullary thyroid carcinoma or MEN 2.
• Do not use these medications during pregnancy or while breastfeeding, and stop them in advance of a planned pregnancy as directed by your provider.
• Your provider will determine whether any medication is appropriate for you. Not all applicants qualify, and no specific result is guaranteed.

5. Alternatives

You do not have to use telehealth. Alternatives include in-person evaluation and treatment with a local provider, lifestyle-only approaches, or no treatment. You may seek in-person care at any time.

6. Emergencies

Telehealth is not for emergencies. If you have severe abdominal pain, symptoms of pancreatitis, an allergic reaction, thoughts of self-harm, or any other emergency, call 911 or go to the nearest emergency room immediately.

7. Privacy

Your health information is handled as described in our Notice of Privacy Practices and Privacy Policy, and is stored in secure, access-controlled systems.

8. Your rights

• You may withhold or withdraw this consent at any time by contacting us; withdrawal does not affect care already provided.
• You may ask questions about your treatment at any time: (813) 563-2799.
• Your provider may determine that telehealth is not appropriate for you and may decline to treat or refer you to in-person care.

9. Acknowledgment

By checking the consent box and typing your name as a signature, you confirm that you have read and understood this consent, that your answers are truthful and complete, that you are 18 or older and the person receiving care, and that you voluntarily consent to receive care via telehealth under these terms and our Terms & Conditions.