Weight Loss Clinic in Cumming, GA — GLP-1 Therapy With Real Medical Support

Telehealth Informed Consent

Last Updated: January 2025

Introduction

This Telehealth Informed Consent explains the nature of telehealth services provided by Hydralive Therapy. By using our telemedicine services, you acknowledge that you have read, understood, and agree to the terms outlined below.

What is Telehealth?

Telehealth involves the use of electronic communications to enable healthcare providers to diagnose, consult, treat, and provide medical services to patients at distant locations. Our telehealth services use secure, HIPAA-compliant video conferencing technology.

Benefits of Telehealth

  • Convenient access to medical care from your home
  • Reduced travel time and costs
  • Access to specialists regardless of location
  • Continuity of care through regular virtual check-ins
  • Flexible scheduling options

Limitations of Telehealth

You understand and acknowledge that:

  • Telehealth is not appropriate for all medical conditions or emergencies
  • Physical examinations cannot be performed remotely
  • Laboratory tests and imaging cannot be conducted through telehealth
  • Technical difficulties may interrupt or prevent telehealth sessions
  • In-person care may be necessary for certain conditions

Patient Responsibilities

As a patient using our telehealth services, you agree to:

  • Provide accurate and complete medical history and health information
  • Inform your provider of all medications, supplements, and allergies
  • Be in a private, quiet location during consultations
  • Have a reliable internet connection for video consultations
  • Attend all required monthly consultations
  • Follow treatment plans and medication instructions as prescribed
  • Report any side effects or concerns promptly
  • Seek in-person care when recommended by your provider

Privacy and Security

We use Qualiphy.me, a secure, HIPAA-compliant telemedicine platform. Your consultations are encrypted and protected. However, you acknowledge that:

  • No electronic communication is 100% secure
  • You are responsible for maintaining the privacy of your login credentials
  • You should be in a private location during consultations
  • You should not record consultations without provider consent

Medical Emergencies

Important: Telehealth services are not appropriate for medical emergencies. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Do not use telehealth services for urgent or life-threatening conditions.

Prescription Medications

You understand that:

  • All medications prescribed are compounded by licensed pharmacies
  • Medications are not FDA-approved for weight loss or specific indications listed
  • Monthly consultations are required to receive prescriptions
  • Individual results may vary
  • You are responsible for proper storage and use of medications
  • You should report any side effects or adverse reactions immediately

Georgia Telemedicine Requirements

In accordance with Georgia law:

  • You must be physically located in Georgia during consultations
  • Our providers are licensed to practice medicine in Georgia
  • A valid provider-patient relationship is established through telehealth
  • You have the right to refuse telehealth services at any time

Consent

By using our telehealth services, you consent to:

  • Receive medical care through telehealth technology
  • The use and disclosure of your health information as described in our Privacy Policy
  • Electronic communication with your healthcare providers
  • The limitations and risks associated with telehealth

You have the right to withdraw this consent at any time by contacting us.

Questions or Concerns

If you have questions about telehealth services or this consent form, please contact us:

Hydralive Therapy
5770 Bethelview Rd., Suite F
Cumming, GA 30040
Phone: 470-758-1809
Email: contactcumming@hydralivetherapy.com

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