Telehealth Informed Consent

Who provides your care

Medical evaluation and treatment are provided by independent, licensed clinicians of Holistic Health and Wellness VA PC (“Program Clinicians”) — not by Insert MD as a medical practice. Insert MD (Rx Group LLC) operates the technology and administrative storefront that connects you with that care and with licensed 503A compounding pharmacies when a prescription is issued.

Your clinician’s credentials are available through the care platform. If you have questions about a clinician’s qualifications, ask your clinician or use Help in the Insert MD website or patient portal so we can help route your request.

Nature of telehealth (synchronous video and asynchronous care)

Telehealth means healthcare delivered using interactive telecommunications technology. We do not use audio-only consultations to prescribe medication. Depending on your state, your medication protocol, and your clinician’s independent medical judgment, your consultation will follow one of these required modalities:

• Synchronous live video (all 50 states for TRT, HRT, and controlled substances): Testosterone replacement therapy (TRT), hormone replacement therapy (HRT), and any controlled substance require a live synchronous video consultation with a licensed clinician and required bloodwork in all 50 U.S. states before a prescription may be issued.
• Synchronous live video (state-specific mandate in 9 jurisdictions): If your state is Arkansas (AR), District of Columbia (DC), Kansas (KS), Mississippi (MS), New Jersey (NJ), New Mexico (NM), Rhode Island (RI), Virginia (VA), or West Virginia (WV), a live synchronous video consultation with a licensed clinician is required for all peptide, weight-management, and prescription medication protocols.
• Asynchronous (“store-and-forward”) review: In eligible states outside the mandatory synchronous-video jurisdictions above and for non-controlled protocols, you complete a structured medical intake, upload a government-issued photo ID (and labs where applicable), and a clinician licensed in your state reviews your submission and may message you or require a live video consultation at their discretion.
• Protocol-specific informed consent: In addition to this Telehealth Informed Consent, you will review and explicitly consent to the medication- and protocol-specific risks, benefits, and compounding disclosures for your selected treatment before your clinical intake is submitted.

Benefits and risks

Benefits can include improved access to care from home, more efficient evaluation, and access to appropriate specialty expertise. Risks and limitations include possible delays if technology fails, incomplete information if you do not answer thoroughly, and rare cases where transmitted information is inadequate and an in-person visit or rescheduled consult is needed.

Your clinician may consult with other licensed clinicians when appropriate. No specific outcome or prescription is guaranteed. A clinician may decline to prescribe or may recommend in-person care.

Limitations and emergencies

• Telehealth is not a substitute for emergency care or all in-person examinations
• Asynchronous consults do not include a real-time physical exam; decisions rely on the information you provide and available clinical data
• Insert MD and the care platform are not for emergencies — call 911 or go to the nearest emergency department
• You are responsible for providing accurate, complete medical history, medications, allergies, and current symptoms

Privacy and security

Electronic systems use security protocols designed to protect confidentiality and integrity of information. Your information is handled as described in our Privacy Policy & Notice of Privacy Practices. Clinical intake and identity documents are transmitted to the care platform for treatment. You agree to complete intake in a reasonably private setting and to keep account credentials secure.

You understand that electronic communications can have residual risks (for example, technical failure or unauthorized access despite reasonable safeguards). We and our partners maintain safeguards required by applicable law, including HIPAA where it applies.

Treatment and medication risks

Medications and treatments that may be prescribed (including weight-management and peptide therapies, when offered) carry risks, side effects, and contraindications. Your clinician will exercise independent medical judgment. Compounded or specialty medications, when used, may have additional considerations your clinician or pharmacy will explain. You agree to follow clinician and pharmacy instructions and to seek urgent care if you experience concerning symptoms.

Technical failure

Electronic systems can fail. You acknowledge that Insert MD and the care platform are not liable for information delayed or lost solely due to technical failure outside reasonable control, to the extent permitted by law, while remaining responsible for safeguarding PHI as required by applicable law.

Consent records

Program Clinicians / the care platform are responsible for obtaining and maintaining any additional telemedicine consent records required for the clinical encounter. This Insert MD acknowledgment is in addition to those clinical consent processes and is versioned for audit (see version stamp above).

Your agreement

By accepting this consent you confirm that you are the patient (or legally authorized representative), that you understand telehealth’s nature and limitations, and that you voluntarily consent to telehealth evaluation and possible treatment through the Program Clinicians and care platform described above.