Telehealth Informed Consent

Last updated: May 1, 2026

Authorization to Use and Disclose Medical Information & Consent to Telehealth.

BY CLICKING “I AGREE,” CHECKING A RELATED BOX, OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS CONSENT. IF YOU DO NOT AGREE, DO NOT CREATE AN ACCOUNT OR USE THE SERVICE.

If you are experiencing a life-threatening situation such as contemplating suicide, call 911 or the 988 Suicide & Crisis Lifeline at 988.

Purpose

The purpose of this consent form (“Consent”) is to provide you with information about telehealth and to obtain your informed consent to the use of telehealth in the delivery of healthcare services to you by physicians, physician assistants, and nurse practitioners (“Providers”) using the online platform owned and operated by iLIFE Telemed LLC (“iLIFE”) (the “Service”). In this Consent, the terms “you” and “yours” refer to the person using the Service.

Use of Telehealth

Telehealth involves the delivery of healthcare services using electronic communications, information technology, or other means between a healthcare provider and a patient who are not in the same physical location. Telehealth may be used for diagnosis, treatment, follow-up, and patient education, and may include, but is not limited to:

Electronic transmission of medical records, photo images, personal health information, or other data between a patient and a Provider;
Interactions between a patient and Provider via audio, video, and/or data communications (such as messaging or email communications);
Use of output data from medical devices, sound, and video files.

Alternative methods of care may be available to you, such as in-person services at iLIFE Anti-Aging Center or at another healthcare provider, and you may choose an alternative at any time. Always discuss alternative options with your Provider.

Anticipated Benefits

The use of telehealth may have the following potential benefits: making it easier and more efficient for you to access medical care or other treatment for the conditions treated by your Provider(s); allowing you to obtain medical care at times that are convenient for you; and enabling you to interact with your Provider(s) without the necessity of an in-office appointment.

Potential Risks

While the use of telehealth in the delivery of care can provide potential benefits, there are also potential risks associated with the use of telehealth and other technology. These risks include, but may not be limited to:

The quality, accuracy, or effectiveness of the services you receive from your Provider could be limited;
Technology, including the Service, may contain bugs or errors that may limit functionality, produce erroneous results, or render the Service unavailable;
The inability of your Provider(s) to conduct certain tests or assess vital signs in person may in some cases prevent the Provider(s) from providing a diagnosis or treatment, or from identifying the need for emergency medical care;
Your Provider(s) may not be able to provide treatment for your particular condition, and you may be required to seek alternative healthcare or emergency care services;
Delays in medical evaluation or treatment could occur due to unavailability of your Provider(s) or deficiencies in technology;
The electronic systems or security protocols used could fail, causing a breach of privacy of your medical information;
Data stored and communicated electronically may be more susceptible to unintended disclosure of protected health information to third parties;
Given regulatory requirements in certain jurisdictions, your Provider(s) diagnosis and/or treatment options may be limited;
A lack of access to all of your medical records may result in adverse drug interactions or allergic reactions or other judgment errors.

Life-Threatening and Emergency Situations

If you are experiencing a life-threatening situation such as contemplating suicide, call 911 or the 988 Suicide and Crisis Lifeline at 988.

If the situation is an emergency, call 911.

In some situations, telehealth is not an appropriate method of care. If you require immediate or urgent care, you must seek care at an emergency room facility or other provider equipped to deliver urgent or emergent care. Providers may not respond promptly to communications you submit through the Service. If you are not experiencing an emergency, you can communicate with Providers through the secure messaging service in the Service. If a technical failure prevents you from communicating with your Providers through the Service, you should contact iLIFE support at support@ilife.med.

Data Privacy and Protection

The electronic systems used in the Service incorporate network and software security protocols to protect the privacy and security of your information and include measures to safeguard data against intentional or unintentional corruption. Personal information that identifies you or contains protected health information will not be disclosed to any third party without your consent, except as authorized by law for the purposes of consultation, treatment, payment/billing, certain administrative purposes, and as required by law or as otherwise set forth in your Provider’s Notice of Privacy Practices.

Use of the Service may include email and SMS communications to and from you that may include your protected health information. You understand that iLIFE does not and cannot guarantee the security or privacy of services you use to receive communications, including for example your email service provider.

Prescription Treatments and Compounded Medications

Certain treatments offered through the Service may include compounded medications. You acknowledge and agree that:

These treatments may be prescribed only after evaluation by a licensed Provider and based on medical history, lab results, and clinical judgment.
Some compounded medications are not FDA-approved and are dispensed under the direction of a licensed prescriber pursuant to applicable state and federal law.
You have had the opportunity to discuss the risks, benefits, and alternatives of these treatments with your Provider.
Outcomes are not guaranteed and may vary by individual.
Your Provider may modify or discontinue treatment at any time based on clinical judgment or new information.

Laboratory Products and Services

Certain healthcare services provided to you by Providers via the Service may include laboratory testing. If determined necessary, a Provider may order laboratory blood testing, either using an at-home collection kit, which will be mailed to you, or you may need to go in-person to a blood collection site to have your blood drawn. You understand the risks involved with blood draws, including but not limited to: discomfort at the site of the blood draw, possible bruising, redness and swelling around the site, bleeding at the site, lightheadedness when blood is being drawn, and rarely, an infection at the site.

These laboratory tests are provided by affiliated and/or third-party laboratories, and neither iLIFE nor your Provider(s) can guarantee the accuracy or reliability of these tests. Laboratory tests can provide false negative, false positive, or inconclusive results.

All tests and results are confidential, but will be disclosed, as appropriate and to the extent of information needed, by and among the Service, its affiliated Providers, and the laboratory that processes your sample.

Open Payments Notice

For informational purposes only, the federal Physician Payments Sunshine Act requires that detailed information about payments and other transfers of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public. The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at openpaymentsdata.cms.gov.

Your Acknowledgments

By clicking “I Agree,” checking a related box, or otherwise affirmatively accepting this Consent, you are agreeing and providing your consent with respect to the following:

Provider Relationship & Treatment

Healthcare services provided to you by Providers via the Service will be provided by telehealth. In some cases, your treating Provider may be a nurse practitioner or physician assistant and not a physician, and you agree to be treated by non-physician Providers, if applicable, by using the Service.

Technology used to deliver care, including the Service, may contain bugs or other errors that could limit or otherwise impact the quality, accuracy, and effectiveness of the medical care you receive from your Provider(s). Certain diagnostic testing services may contain defects that could limit or otherwise impact the quality, accuracy, or effectiveness of the medical care you receive.

No potential benefits from the use of telehealth or specific results can be guaranteed, including any laboratory testing results or related diagnosis or treatment by your Provider(s). Your condition may not be cured or improved, and in some cases may get worse.

Your Provider(s) will assess your medical condition and, in their sole discretion, may determine it is medically appropriate to diagnose and/or treat your condition via telehealth. By continuing to use the Service, you concur with your Provider’s medical assessment and agree to receive a diagnosis and/or treatment via telehealth technology.

You have the right to withdraw your consent to the use of telehealth in the course of your care, without prejudice to any future care or treatment, but you understand that the Providers who utilize the Service do not offer in-person treatment through the Service. Any withdrawal of your consent will be effective upon receipt of written notice to your Providers, except that such withdrawal will not have any effect on any action taken by iLIFE or your Provider(s) in reliance on this Consent before it received your written notice of withdrawal.

You understand that it is your duty to provide iLIFE and your Provider(s) truthful, accurate, and complete information, including all relevant information regarding care that you may have received or may be receiving from healthcare providers, including emergency contact information for your local healthcare providers.

Pharmacy & Lab Relationships

iLIFE has a commercial relationship with one or more compounding pharmacies, dispensing pharmacies, and laboratory partners (which may include but is not limited to partners such as Remo, OpenLoop, Quest Diagnostics, and Labcorp) that fulfill orders and laboratory services through the Service. iLIFE has a financial relationship with the entity that employs or contracts with your Provider.

You are free to obtain your medical examination from another healthcare provider that is not associated with iLIFE. iLIFE will use its pharmacy partners to fulfill your order directly to your door. You are free to obtain your prescription from any pharmacy of your choice by contacting our support team. Prescriptions may be filled by and transferred between any pharmacy partners on your behalf.

You must pay the full amount of the costs associated with use of the Service, including any prescription you may receive, and you will not attempt to submit a claim to Medicare, any other federal payor, or any state or private insurer.

State Notices

If you have a concern about a medical professional, you may contact the Medical Board in your state regarding your concerns.

Special Notice to Texas Patients. Physicians are licensed and regulated by the Texas Medical Board. To confirm a license or file a complaint, visit www.tmb.state.tx.us or call (800) 248-4062.

Special Notice to California Patients. Physicians are licensed and regulated by the Medical Board of California. To confirm a license or file a complaint, go to www.mbc.ca.gov or call (800) 633-2322.

Contacting Us

If you have any questions about this Consent, please contact us at support@ilife.med or:

iLIFE Telemed LLC
2401 Fountain View Drive
Houston, TX 77057