Universal Informed Consent for Telehealth and Treatment Services

Effective Date: June 9, 2025

By accessing services through Primal Health and Wellness LLC, you voluntarily consent to receive medical care through telehealth, including the use of compounded medications when medically appropriate. This universal informed consent outlines the general terms, risks, and responsibilities associated with receiving virtual healthcare services from licensed medical providers.

Telehealth Disclosure

Telehealth involves the delivery of healthcare services via secure electronic communication technologies, including video conferencing, secure messaging, and digital intake forms. By consenting to telehealth services, you acknowledge:

• You may not be physically examined in-person.
• Your provider will rely on the accuracy of the information you provide.
• Services are not intended for emergency care or urgent conditions.
• Care is provided only by licensed medical professionals authorized in your state.

Scope of Treatment

Our providers may evaluate you for and prescribe treatment related to, but not limited to:

• Medical weight loss with GLP-1 and GLP-1/GIP receptor agonists
• Hormone optimization (TRT and women’s HRT)
• Sexual health and performance enhancement therapies

All prescriptions are issued only when deemed medically appropriate by your provider.

Use of Compounded Medications

Some prescribed medications may be compounded and are not FDA-approved. These medications are:

• Formulated by licensed 503A or 503B compounding pharmacies
• Prepared specifically for your individual treatment plan
• Used only when a commercially available FDA-approved alternative is unsuitable

You acknowledge understanding that compounded medications may carry additional risks due to lack of FDA review.

Potential Risks

All medical treatments carry potential risks. General and treatment-specific risks may include (but are not limited to):

• Medication side effects or allergic reactions
• Hormonal imbalances or lab abnormalities
• Changes in mood, weight, or energy levels
• Gastrointestinal, cardiovascular, or endocrine complications

You will be provided with detailed consent related to the specific treatment you are being prescribed.

Patient Responsibilities

• Provide accurate, complete medical and personal history
• Report any adverse reactions, side effects, or concerns immediately
• Follow the treatment plan and instructions as directed
• Complete follow-up labs or assessments when required
• Continue general care with your primary care provider

Right to Refuse or Withdraw

You may refuse or discontinue treatment at any time. Withdrawal may result in cancellation of prescriptions or follow-up care. Please notify us if you wish to revoke consent.

Privacy & HIPAA Compliance

Your data is stored on secure, HIPAA-compliant platforms. Only authorized personnel have access to your medical information. Please review our Privacy Policy for more details.

No Guarantees or Endorsements

We do not guarantee specific health outcomes or results. We are not affiliated with, endorsed by, or associated with Novo Nordisk, Eli Lilly, or any branded pharmaceutical manufacturers.

Contact Us

If you have questions or concerns about this consent, please contact us:

Primal Health and Wellness LLC
Email: [email protected]
Website: www.primalhealthandwellness.com