You acknowledge that you have read, accepted, and agreed to this consent when you click “I agree,” check an acceptance box, submit your information to Alpha Hormones Inc., or use another acceptance method provided through the service.
If you do not agree, do not create an account or use these services. You authorize anyone who accepts this consent on your behalf to act as your agent for that purpose.
Purpose of this consent
This form explains telehealth and asks for your informed consent to receive healthcare through it. Physicians, physician assistants, and nurse practitioners (“Providers”) deliver these services through online platforms owned and operated by Alpha Hormones Inc. (“the Company”).
How telehealth works
Telehealth uses electronic communication to let healthcare providers in different locations share medical information and support patient care. Providers may include primary care practitioners, specialists, and subspecialists.
Information may be used for diagnosis, treatment, follow-up, or education. It may include:
- Patient medical records.
- Medical images.
- Live, two-way audio and video.
- Data from medical devices, along with audio and video files.
The electronic systems use network and software security protocols to protect patient identity and medical images. Safeguards also help protect data from intentional or accidental damage or alteration.
Possible benefits
Telehealth may help you:
- Access care more easily and efficiently for conditions your provider treats.
- Receive care at convenient times.
- Meet with your provider without an office visit.
- Access the expertise of a specialist in another location.
Possible risks and limitations
Like other forms of medical care, telehealth has risks. These include, but are not limited to:
- Technology errors: Software bugs and other errors may limit functionality or make systems unavailable. They may produce incorrect results or records, or cause records, transmissions, data, or content to be lost or corrupted. This can affect the quality, accuracy, or effectiveness of your care.
- Diagnosis and treatment limits: Technology failures may affect your provider’s ability to diagnose or treat your condition correctly.
- Limits on examinations: Your provider cannot perform certain tests or check some vital signs in person during a telehealth visit. This may prevent a diagnosis or treatment, or make it harder to identify a need for emergency care.
- Other care may be needed: Your provider may be unable to treat your condition through telehealth. You may need another healthcare service or emergency care.
- Delays: Provider availability, equipment problems, or technology failures may delay evaluation or treatment.
- Privacy risks: In very rare cases, electronic systems or security safeguards may fail and expose medical or other private information.
- Regulatory limits: Rules in some jurisdictions may limit diagnosis, treatment, or prescription options.
- Incomplete records: In rare cases, missing medical records may contribute to adverse drug interactions, allergic reactions, or other errors in clinical judgment.
Follow-up care and emergencies
If you have an emergency, call 911. Telehealth is not appropriate for every situation. If you need immediate or urgent care, seek help at an emergency department or another provider equipped to deliver that care.
For nonurgent needs, you can contact your provider through secure messaging in the Patient Portal. If a technical problem prevents you from using the Patient Portal or Klara, our secure HIPAA-compliant communication system, call (213) 334-4111.
Data privacy and protection
The Company’s electronic systems use network and software security protocols to protect your information. These include safeguards against intentional or accidental data damage or alteration.
Information that identifies you or contains protected health information will not be shared with third parties without your consent, except as authorized by law. Exceptions include consultation, treatment, payment, billing, certain administrative purposes, and disclosures described in our Privacy Policy.
What you acknowledge and agree to
By accepting this consent through the methods described above, you acknowledge and agree to the following terms.
Telehealth and technology
- Your providers will deliver healthcare through the Company using telehealth.
- Some technology may still be in beta testing or development and may not be a finished product.
- Technology errors may limit functionality, create incorrect results, or make systems unavailable. Records, transmissions, data, or content may be incorrect, corrupted, or lost. These problems may affect the quality, accuracy, or effectiveness of your care.
- Telehealth is an evolving field. Your care may use technology in ways that differ from, or are not specifically described in, this consent.
- Benefits and specific results are not guaranteed. Your condition may not improve or be cured and may become worse.
- Telehealth has limits. You may not be able to receive a diagnosis or treatment for every condition through it.
- You understand that telehealth and other technology carry risks, including those described in this consent.
- Telehealth involves sending your personal medical information electronically to your providers.
Your privacy during a consultation
If anyone other than your healthcare provider is present, you will be told. Those present must keep your information confidential. You may ask to:
- Leave out personally sensitive details of your medical history or physical examination.
- Have nonmedical personnel leave the telehealth examination room.
Your choices and withdrawal of consent
- You may discuss telehealth with your provider, including its benefits, risks, and alternatives.
- You may withdraw consent to telehealth without affecting your right to future care or treatment or losing health benefits to which you are entitled. However, you understand that providers who use the Company do not offer in-person treatment.
- Withdrawal takes effect when your providers receive written notice. It does not affect actions the Company or your providers took in reliance on this consent before receiving that notice.
- Withdrawal does not affect the other provisions of this consent. You remain bound by those provisions.
- You may obtain a medical examination from another healthcare provider who is not associated with the Company.
Your information and care decisions
- You must give Alpha Hormones and your providers truthful, accurate, and complete information. This includes relevant information about care you have received or are receiving elsewhere.
- Each provider may decide, at their sole discretion, that your condition is not suitable for telehealth diagnosis or treatment. You may need care outside telehealth from that provider, a specialist, or another healthcare provider.
Pharmacies, laboratories, and costs
- Alpha Hormones uses its compounding pharmacy partner to deliver your order to your door. You may choose another compounding pharmacy by contacting our support team.
- Alpha Hormones uses Quest, LabCorp, and other specialty laboratories for diagnostic tests. You may use any laboratory company for your tests, including blood spot, blood serum, wet or dry urine, and saliva tests.
- You have sole financial responsibility for using the Company and for products provided to you. You must pay the full associated costs, including any prescription you receive.
Your informed consent
By accepting this consent, you confirm that:
- The alternatives to a telehealth consultation have been explained to you, and you choose to participate in telehealth with the Company.
- You have spoken directly with your healthcare provider and had the opportunity to ask questions. Your questions have been answered, and the risks, benefits, and practical alternatives have been discussed in a language you understand.
- You have read and understood this information and discussed it with your physician or their designated assistants. All your questions have been answered to your satisfaction.
- You give informed consent to the use of telehealth in your medical care. You authorize Alpha Hormones Inc. and its associates to use telehealth for your diagnosis and treatment.
Effective: January 1, 2020
