By participating in Compound Meds Direct services, you implicitly agree to the terms outlined in the medical consent. You acknowledge that you have read or have had read to you the consent below and understand the information presented.

The utilization of medications for weight management is recommended for individuals with a BMI of 30 or higher, or a BMI of 27 or higher with additional medical conditions like high blood pressure, diabetes, or high cholesterol. Weight-loss treatment is an elective service and carries potential risks. By voluntarily participating in this medically managed program, you agree to hold Compound Meds Direct LLC and its independent providers harmless for the use of such medications.

You understand that weight-loss results vary among individuals and are significantly influenced by each patient’s adherence to diet and exercise. No guarantees or specific claims about results are stated or implied. You acknowledge the importance of regular follow-ups with Compound Meds Direct and your Primary Care Provider. You understand that this monitoring is essential for safety and agree to comply with follow-up recommendations.

You authorize Compound Meds Direct and its independent providers to evaluate you for admission into the program and provide treatment. You agree to continue routine medical care with your primary care provider, including blood work. You certify that you are participating voluntarily and are competent to make your own medical decisions.

You acknowledge the risks discussed and agree that the potential benefits outweigh them. You release Compound Meds Direct, its Independent Providers, and associated staff from any claims or complaints related to your treatment.

You understand that some treatment modalities used by Compound Meds Direct may not be supported by scientific or medical literature and may be considered experimental. You also understand that medications used in this program are compounded and do not undergo FDA pre-market approval. As a result, variations in dose, effects, and efficacy may occur compared to brand-name drugs.

Telehealth Consent

Telehealth involves providing behavioral health services through audio–video communication systems. These systems use security protocols to protect confidentiality, identification data, and imaging.

Expected Benefits:• Improved access to behavioral health care across distances• More efficient evaluation and management• Access to distant specialists• Ability to maintain continuity with established providers

Possible Risks:• Insufficient information transmission for accurate decision-making• Delays due to equipment issues• Rare failures in security protocols leading to privacy risks• Limited access to complete medical records, potentially affecting outcomes

By consenting, you understand:• Privacy laws apply to telehealth• You may withhold or withdraw consent at any time• You may review information obtained during telehealth sessions• In-person alternatives are available• It is in your best interest to inform all providers involved in your care• Benefits are expected but not guaranteed

Client Consent to the Use of Telehealth

You have read and understand the telehealth information, discussed it with your provider, and give informed consent for its use within Compound Meds Direct services.

HIPAA Consent

The Health Insurance Portability and Accountability Act (HIPAA) protects the confidentiality of your Protected Health Information (PHI). This is a simplified summary; a complete version is available in the office and online.

Overview:HIPAA regulates who may access or receive your PHI. These rules do not interfere with the normal exchange of information required for treatment, billing, or administration. You are entitled to specific rights and protections under HIPAA.

Adopted Policies:• Patient information will be kept confidential and shared only as required for care or administrative purposes.• Files may be stored without condition-specific labels.• Appointment reminders may be sent via phone, email, mail, or other preferred methods.• Approved vendors may access PHI but must adhere to HIPAA rules.• Agencies and insurance payers may review PHI during normal duties.• Concerns or complaints regarding privacy should be reported to the office manager or doctor.• Your information will not be used for marketing.• You may access your medical records as permitted by law.• Policies may be modified as needed.• You may request PHI restrictions, though the practice is not obligated to adopt them.

Consent

By continuing to use the services, you acknowledge and accept the terms in this HIPAA Information Form. This consent remains active moving forward.

Financial Consent

You agree to keep a credit card on file and authorize all associated charges. You consent to automatic renewal of programs and automatic billing. No refunds or exchanges are offered.

Shipping Authorization

You understand that medications will be dispensed according to state and federal laws. You hold Compound Meds Direct LLC harmless for any shipping delays or errors. You authorize shipment of medication to your provided address and agree to the stated conditions.

Your continued use of the services signifies your understanding and acceptance of all terms above.