Telehealth Informed Consent

1. Purpose of this consent

This document explains what telehealth is, how care is delivered through Puritas, and the benefits, risks, and limitations involved, so that you can make an informed decision about whether to proceed. Most states require that a patient give informed consent before receiving telehealth services, and this document is intended to satisfy that requirement.

Read it in full before you submit an intake. Ask questions at support@puritasrx.com or 1-800-000-0000 if anything is unclear. Your provider may also ask you to sign a separate consent specific to their practice or to a particular treatment; that consent supplements this one.

2. What telehealth is and how care is delivered

Telehealth is the use of electronic communications to deliver health care when you and the clinician are in different locations. Care through Puritas is delivered primarily asynchronously — also called "store-and-forward." You complete a detailed medical intake, and a licensed clinician reviews your answers, your history, and any photographs or measurements you supply, at a later time. There is not necessarily a live video or telephone visit.

Where the law of your state requires a real-time interaction, or where the provider decides one is clinically necessary, you will be asked to complete a live telephone or video consultation before a prescription can be issued.

Communication after the initial review — follow-up questions, dose adjustments, refill requests — normally takes place by secure message, email, or telephone.

3. Your provider and the patient–provider relationship

Your intake is reviewed by an independent clinician in our provider network, [Provider Network Name]. Providers hold active MD, DO, NP, or PA licenses in the state where you are located, and they exercise their own independent professional judgment. Puritas does not practice medicine and does not direct or influence clinical decisions. Provider credentials are described on our providers & pharmacy page and are available on request.

By submitting an intake you are requesting that a provider review your information for the purpose of establishing a patient–provider relationship and determining whether treatment is appropriate. The provider may decline to establish that relationship or to prescribe.

Puritas is not a substitute for a primary care clinician. We strongly encourage you to have one, and to tell them about any treatment you receive through us.

4. Scope of services — and what we do not provide

Through Puritas you can be evaluated for treatments in the categories we publish on this site.

We do not provide:

• emergency or urgent care of any kind;
• controlled substances;
• in-person examinations, imaging, or procedures;
• ongoing primary care, mental health crisis care, or management of complex conditions;
• care for anyone under 18;
• care for people located outside the states we serve.

Puritas is available in most U.S. states. We do not currently serve California, Louisiana, Mississippi. Individual treatments may be further restricted by state law.

5. Expected benefits

• Access to a licensed clinician without travel or a scheduled appointment.
• Evaluation on your own schedule, including outside normal office hours.
• Access to care for people in areas with limited local availability.
• Medication shipped directly to you in discreet packaging.
• Privacy and convenience for conditions people may be reluctant to discuss in person.

6. Risks and limitations

Telehealth carries risks that do not exist, or exist differently, in an in-person visit. You should understand and accept these before proceeding:

• No physical examination. Your provider cannot examine you, listen to your heart or lungs, or perform in-person testing. A condition that would be detected in person may be missed.
• Reliance on the information you give. The evaluation is only as good as your answers. Incomplete or inaccurate information can lead to an incorrect assessment, an inappropriate prescription, a harmful drug interaction, or a delayed diagnosis.
• Delays. Asynchronous care means a provider may not respond immediately. Technology failures, transmission errors, or poor image quality can delay or prevent evaluation.
• Security. Although we use secure systems, no electronic transmission or storage is completely secure. There is a small risk that a protocol failure could allow unauthorized access to your health information.
• Clinical limits. Some conditions cannot be appropriately diagnosed or treated by telehealth. Your provider may determine that you need to be seen in person and decline to treat you.
• Fragmented care. Care delivered outside your usual clinician's office may not be reflected in your local medical record unless you share it.

7. No guarantee of treatment or of results

Completing an intake or paying a fee does not entitle you to a prescription. The provider may decline to prescribe, may prescribe something different from what you requested, or may require laboratory work or an in-person evaluation first. No one can guarantee that a treatment will improve your condition, and individual results vary. As with any medical care, the outcome cannot be predicted.

8. Compounded medications

Some treatments offered through Puritas are compounded — prepared by a licensed compounding pharmacy for an individual patient rather than manufactured in advance.

• Compounded medications are not FDA-approved. The FDA does not review them for safety, efficacy, or manufacturing quality.
• They are not generic equivalents of, and have not been shown to be therapeutically equivalent to, any brand-name product.
• Potency, purity, and stability depend on the compounding pharmacy's practices, and batch-to-batch variation is possible.
• Compounded formulations may contain different inactive ingredients from a commercially available product, which matters if you have allergies or sensitivities.

Your provider will discuss whether a compounded option is appropriate for you. If you would prefer an FDA-approved commercially manufactured product, tell your provider, and speak with your local clinician or pharmacist about your options.

9. Medication risks, side effects, and adverse events

All medications carry risks, including side effects, allergic reactions, and interactions with other drugs, supplements, alcohol, and foods. Some risks are serious. Your provider will discuss the risks relevant to any medication they prescribe, and the medication will arrive with information from the pharmacy that you should read before taking it.

Take medication only as prescribed. Do not increase or decrease your dose on your own. Tell us and your provider about every medication, supplement, and health condition you have, including pregnancy or plans to become pregnant, and any change to them.

If you experience a side effect or an adverse reaction: stop use if directed, seek medical care, and report it to your provider and to us at safety@puritasrx.com or 1-800-000-0000. You may also report directly to the FDA MedWatch program at fda.gov/medwatch or 1-800-FDA-1088. For a medical emergency, call 911.

10. Your responsibilities

By proceeding, you agree to:

• give complete, accurate, and truthful information about your health history, medications, allergies, and symptoms, and update it when it changes;
• confirm your identity, your age, and the state you are physically located in;
• use medication exactly as prescribed, and not share it with anyone;
• attend any laboratory work, follow-up, or in-person evaluation your provider recommends;
• tell your other clinicians about the treatment you receive through Puritas, so your care is coordinated;
• respond to messages from your provider or from us about your treatment, and keep your contact details current;
• seek in-person or emergency care when your symptoms warrant it.

11. Medical records and privacy

Information you submit becomes part of your medical record and is protected by federal and state privacy law, including HIPAA. It is shared with the provider who reviews it, the pharmacy that dispenses your medication, and the service providers necessary to deliver your care. Your rights in that record — access, amendment, restrictions, confidential communications, and an accounting of disclosures — are described in our Notice of Privacy Practices. Other information is handled under our Privacy Policy. We will not record a video consultation without telling you and obtaining your consent.

12. Fees and billing

Puritas is a self-pay service. We do not bill insurance, Medicare, or Medicaid, and amounts you pay are unlikely to count toward a deductible. Fees are shown before you confirm, and your payment method is charged only after a provider approves treatment. Most treatments are billed as a recurring subscription until you cancel. Billing, cancellation, and refund terms are in our Shipping, Cancellation & Refunds policy and our Terms of Service.

13. Emergencies

Telehealth is not appropriate for emergencies. If you believe you are having a medical emergency, call 911 or go to the nearest emergency room. If you are in crisis or thinking about harming yourself, call or text 988 to reach the Suicide and Crisis Lifeline. Do not use email, secure messaging, or text messages to report an urgent problem — they are not monitored continuously.

14. Alternatives to telehealth

You are free to choose care in person instead. Alternatives include seeing your primary care clinician, a specialist, an urgent care clinic, or a community health center; obtaining medication through a local pharmacy; and non-medication approaches your clinician may recommend. You may seek in-person care at any time, including while receiving treatment through Puritas.

15. Withdrawing your consent

Your consent is voluntary. You may withdraw it at any time, for any reason, by contacting support@puritasrx.com or 1-800-000-0000, without affecting your right to future care elsewhere. Withdrawing consent stops future telehealth services. It does not undo care already provided, does not automatically cancel a subscription — see our cancellation policy — and does not require destruction of records we are legally obliged to retain.

16. State-specific requirements

Telehealth is regulated state by state. Some states impose additional consent, documentation, examination, or follow-up requirements, restrict which conditions may be treated asynchronously, or require a real-time interaction before a first prescription. Where your state's law requires more than this document provides, that law controls, and your provider will obtain any additional consent it requires. Nothing in this document waives a right your state grants you.

17. Questions and complaints

Clinical questions should go to your provider. For anything else — including a complaint about the service or about a provider — contact us:

Puritas Telehealth, LLC
000 Example Street, Suite 000
City, ST 00000
Support: support@puritasrx.com · 1-800-000-0000
Report a side effect: safety@puritasrx.com

You may also contact the medical licensing board of the state in which your provider is licensed.

18. Acknowledgment

By submitting an intake or accepting treatment through Puritas, you confirm that you:

• have read and understood this consent, and have had the opportunity to ask questions;
• understand the nature, benefits, risks, and limitations of telehealth, and the alternatives available to you;
• understand that no prescription and no particular result is guaranteed, and that some treatments may be compounded and are not FDA-approved;
• are at least 18 years old and are physically located in a state we serve;
• consent voluntarily to receive care through telehealth, and understand you may withdraw that consent at any time.