Telehealth Informed Consent

Effective date: August 21, 2026  ·  Last updated: August 21, 2026

1. What telehealth is

Telehealth is the delivery of healthcare services using electronic communications — including secure messaging, online questionnaires, photographs, telephone, and video — where the patient and the provider are in different physical locations. Through EmberRx, a licensed provider reviews the information you submit and, where appropriate, conducts an evaluation and may issue a prescription without an in-person physical examination.

2. Scope of services

EmberRx LLC operates a technology platform. EmberRx is not a medical practice or a pharmacy and does not practice medicine. Providers reachable through the platform are independent, licensed professionals who exercise their own clinical judgment. Medications are prepared and dispensed by independently licensed pharmacies.

The Services are intended for adults 18 years or older located in the United States, in states where our affiliated providers are licensed. The Services address specific wellness and performance-related concerns and are not a substitute for a primary care provider or for comprehensive, ongoing medical care.

3. Potential benefits

• Access to licensed providers without travel or scheduling an in-person visit;
• More convenient and often faster clinical review;
• Greater privacy and discretion than an in-office visit;
• Direct delivery of prescribed medication, where appropriate;
• Improved continuity through a single portal for messaging and records.

4. Risks & limitations

Telehealth carries risks and limitations that differ from in-person care. By consenting, you acknowledge that you understand and accept the following:

• No physical examination. The provider will not physically examine you. Conditions that would be detected during an in-person exam may go undetected.
• Reliance on the information you provide. Clinical decisions depend heavily on the accuracy and completeness of your self-reported history. Incomplete or inaccurate information can lead to an inappropriate treatment decision, an adverse reaction, or a missed diagnosis.
• Technology limitations. Transmission failures, poor image quality, connectivity problems, or equipment failure may delay or prevent evaluation, or may result in information being unavailable to the provider.
• Security. Although we use reasonable safeguards, no method of electronic transmission or storage is completely secure. In rare circumstances, protocols could fail or information could be accessed without authorization.
• Delays. Clinical review, pharmacy processing, laboratory turnaround, or shipping may be delayed for reasons outside our control.
• Possible need for in-person care. The provider may determine that telehealth is not appropriate for your situation and may direct you to seek in-person evaluation or emergency care.
• Side effects. Any medication carries the risk of side effects, allergic reaction, or interaction with other drugs or supplements. Discuss all medications, supplements, and conditions with your provider.

5. Not for emergencies

If you are in crisis, you can also reach the 988 Suicide & Crisis Lifeline by calling or texting 988.

6. No guarantee of prescription or outcome

Completing an intake, submitting information, or providing a payment method does not guarantee that you will be prescribed any medication. The treating provider may decline to prescribe, may request additional information or laboratory work, may recommend an alternative, or may refer you for in-person evaluation.

Individual results vary and are influenced by many factors, including diet, exercise, sleep, adherence, genetics, and underlying medical conditions. No specific outcome is promised or guaranteed.

7. Compounded medications

Certain medications prescribed through the Services are compounded — prepared by a state-licensed compounding pharmacy for an individual patient.

8. Your responsibilities

By consenting to telehealth services, you agree that you will:

• Provide accurate, complete, and current information about your identity, medical history, conditions, allergies, medications, and supplements;
• Promptly inform your provider of any change in your health, any new medication, and any side effect or adverse reaction;
• Follow the treatment plan, dosing instructions, and monitoring recommendations you are given, and complete any laboratory testing requested;
• Use medication only as prescribed, only for yourself, and never share it with another person;
• Store medication safely and as directed, and dispose of unused medication appropriately;
• Maintain a relationship with a primary care provider for comprehensive care.

9. Records, privacy & HIPAA

Information you share during telehealth encounters becomes part of your medical record and is protected under applicable federal and state law, including HIPAA where it applies. Records may be shared among your treating provider, the dispensing pharmacy, and laboratory partners as necessary to deliver care, and otherwise as permitted or required by law.

You have the right to access your medical records and to request corrections, subject to applicable law. For details on how information is collected, used, and protected, see our Privacy Policy.

Recording. You agree not to record any telehealth encounter without the express written consent of the provider.

10. Follow-up, labs & monitoring

Your provider may require baseline or periodic laboratory testing before prescribing or continuing treatment, and may adjust or discontinue treatment based on those results, your reported response, or new information. Failure to complete requested testing or follow-up may result in treatment being paused or discontinued. Continued care is at the provider's clinical discretion.

11. Provider licensure & availability

You will be evaluated by a provider licensed in the state where you are located at the time of the encounter. You agree to accurately disclose your location and to notify us if you relocate, as this may affect whether services can continue. Services are not available in all states, and availability may change.

12. Withdrawing consent

Your participation is voluntary. You may withhold or withdraw consent to telehealth services at any time, without affecting your right to future care or treatment through other means, and without penalty beyond amounts already owed for services rendered. To withdraw consent, contact support@emberrx.co. Withdrawing consent may end your ability to receive care through the platform.

You may also decline telehealth and instead seek in-person care from a provider of your choosing at any time.

13. Acknowledgment & consent

By checking the consent box, submitting an intake form, or otherwise using the Services, you acknowledge and agree that:

• You have read and understand this Telehealth Consent;
• You have had the opportunity to ask questions, and any questions you asked have been answered to your satisfaction;
• You understand the benefits, risks, and limitations of telehealth described above, including that no in-person physical examination will be performed;
• You understand that no specific result or prescription is guaranteed;
• You understand that some medications may be compounded and are not FDA-approved;
• You are at least 18 years old and are located in the United States;
• The information you provide is accurate and complete to the best of your knowledge; and
• You voluntarily consent to receive healthcare services via telehealth under the conditions described here.

This consent works alongside our Terms of Service and Privacy Policy.

14. Contact us

Questions about telehealth services or this consent:

• Email: support@emberrx.co
• EmberRx LLC
  7901 4th St N, Ste 300
  St. Petersburg, FL 33702