Telehealth Informed Consent

Telehealth involves the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up and/or education.

Improved access to medical care by enabling a patient to remain in their home or office. More efficient medical evaluation and management. Obtaining expertise of a distant specialist.

As with any medical procedure, there are potential risks associated with the use of telehealth. These risks include, but may not be limited to: Information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the physician and consultant(s). Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment. In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information.

All prescriptions and treatment plans are issued only after a thorough medical evaluation conducted by a licensed healthcare provider, at the provider's clinical discretion. Submitting an intake form, completing payment, or contacting MIA Health does not guarantee that a prescription will be issued. The provider may decline to prescribe, request additional information, or recommend an alternative treatment when clinically appropriate.

Many of the peptide therapies and personalized treatments offered through MIA Health are compounded medications, prepared by a state-licensed compounding pharmacy on the basis of an individual prescription written for you specifically by a licensed provider.

IMPORTANT: Compounded medications are NOT approved by the U.S. Food and Drug Administration (FDA). The FDA does not evaluate compounded preparations for safety, effectiveness, or quality of the finished product. The provider's decision to prescribe a compounded formulation is based on individual clinical judgment regarding your specific medical needs.

Nothing on this platform should be interpreted as implying that any compounded formulation is FDA-approved, FDA-evaluated, or equivalent to a commercially manufactured FDA-approved drug.

Peptide therapies carry treatment-specific risks that you must understand and accept before initiating treatment.

Topical peptides (e.g., GHK-Cu / copper peptides) may cause local skin irritation, redness, or contact sensitivity. They are CONTRAINDICATED during pregnancy, lactation, and in individuals with disorders of copper metabolism (such as Wilson's disease).

Growth-hormone-stimulating peptides (e.g., Sermorelin, Tesamorelin, Ipamorelin, CJC-1295) require ongoing clinical monitoring and lab evaluation. They are NOT appropriate for everyone — patients with active malignancy, certain endocrine conditions, severe sleep apnea, or pregnancy must not use these therapies. Side effects may include injection-site reactions, water retention, joint pain, headache, flushing, or alterations in blood glucose.

GLP-1 receptor agonists (e.g., Semaglutide, Tirzepatide) carry boxed and labeled warnings regarding thyroid C-cell tumors, pancreatitis, gallbladder disease, hypoglycemia (especially when combined with other glucose-lowering agents), and diabetic retinopathy progression.

You agree that you have disclosed all current medications, medical conditions, allergies, and pregnancy status truthfully on the intake form, and that you will report any new symptoms or adverse reactions to your provider promptly.

Many peptide and injectable therapies prescribed through MIA Health are shipped directly to your address for at-home self-administration. You acknowledge and agree that:

— You will follow the written and video instructions provided with your medication for storage, preparation, dosing, injection technique, and sharps disposal.

— You will not share your medication with another person, even one with similar symptoms or conditions.

— You assume responsibility for the proper administration of the medication and understand that improper technique can lead to infection, dosing errors, injection-site complications, or therapeutic failure.

— You will contact your provider or seek emergency medical care if you experience signs of allergic reaction, infection, or any unexpected adverse effect.

By accepting this consent you acknowledge that you have read and understand the information above, that you have had the opportunity to ask questions, and that you give your informed consent to participate in a telehealth consultation and to receive prescription, compounded, or self-administered treatments under the terms described. This consent will be recorded with your IP address, browser user-agent, and a timestamp as evidence under HIPAA § 164.508 and applicable state telehealth statutes (including Florida Statute § 456.47).