Consent to Tele-Health

Telehealth Consent · Treatment-Specific Consent · Consent to Text and Email Communication · Authorization to Use and Disclose Health Information

Our clinicians do not handle medical emergencies. If you think you are having an emergency, call 9-1-1 or go to the nearest emergency department. For a mental health crisis, call or text 988.

By clicking "I consent," checking a related box, or otherwise affirmatively accepting this consent, you confirm that you have read, understood, and agree to it. If someone accepts on your behalf, you authorize them to do so. If you do not agree, do not create an account or use the Services.

1. Consent to telehealth

Telehealth is the delivery of healthcare using communication technology — secure intake forms, messaging, photo and document uploads, and, when clinically appropriate, live phone or video visits — to support evaluation, diagnosis, treatment, education, and follow-up. This consent explains how telehealth works through the platform operated by HC Smart, Inc. DBA PeptidesQ / MD Hotline ("PeptidesQ") and asks for your informed agreement to receive care this way from independently licensed physicians, nurse practitioners, physician assistants, and other clinicians ("Providers") who are located remotely from you.

The Providers, and the professional medical entities they practice through, are referred to as the "Practice." This consent adds to, and does not replace, our Terms & Conditions and Privacy Policy. By accepting, you confirm you have had the chance to ask questions, that your questions were answered, and that you understand the benefits, risks, and limits of telehealth. Privacy questions can be sent to privacy@peptidesq.com or to Privacy Officer, HC Smart, Inc. DBA PeptidesQ / MD Hotline, 20900 NE 30th Ave, Ste 200, Aventura, FL 33180.

2. Treatment-specific consent

By accepting this consent, I understand and agree that:

My visits take place by video, phone, or asynchronous (form and message based) technology, and my Provider will not be physically present with me.
The Practice may import and review my medical records, including lab results and my medication list with dosages.
I will complete visits in a private location, as will my Provider. If anyone else is present (for example to help with translation or technology), I will be told who they are and may agree or decline.
Telehealth carries risks such as interruptions, delays, unauthorized access, data errors, and recording or software failures. Either my Provider or I may end a visit if the connection is inadequate. I agree to hold harmless the Practice and PeptidesQ, and their employees, contractors, agents, officers, directors, owners, successors, and assigns, for service delays or lost information caused by such technical failures.
Artificial intelligence. The platform or my Provider may use AI tools to help with transcription, organizing intake information, generating summaries, quality review, or clinical decision support. These tools support — and never replace — my Provider's judgment, and my Provider reviews any AI-assisted output before making decisions. I may ask what tools are used and, where feasible, request that AI not be used in parts of my care.
Recordings. If a live visit is recorded for documentation, quality, or care coordination, I will be told at the start. Recordings are kept according to law and Practice policy, and I may request access to them as the law allows.
My Provider may be a nurse practitioner or physician assistant rather than a physician.
A medication may be prescribed for an off-label use (a use not approved by the FDA), and my Provider will explain the reasons, potential benefits, risks, and alternatives.
I could choose an in-person visit instead and am voluntarily choosing telehealth. My Provider may not have my complete records and cannot examine me in person, which could lead to issues such as drug interactions or allergic reactions.
Telehealth technology, including the platform, is evolving and may contain bugs or errors that affect functionality, data accuracy, or availability, which could in turn affect the care I receive. Not every condition can be diagnosed or treated by telehealth.
All information I provide is true, accurate, and complete, and I will update my Provider if my health or medications change.
My Provider may decide telehealth is not appropriate for my concern. If so, I will be notified and will need to seek care another way.
A visit does not guarantee a prescription. Whether to prescribe is solely my Provider's professional decision, and no specific result is guaranteed — my condition may not improve and could get worse.
Although the platform offers access to partner pharmacies and laboratories, I may ask to use a pharmacy or lab of my choice where clinically and legally possible.
I am responsible for paying any amounts owed for my care.
Providers do not manage emergencies through the platform and may direct me to emergency services.
PeptidesQ is an intended third-party beneficiary of this consent and may enforce it.

3. Authorization to use and disclose health information

I authorize Providers to use and disclose my protected health information, including my full medical record, for the purpose of my telehealth treatment, including sharing prescriptions with partner pharmacies and orders with laboratories. I understand that:

If information is shared with someone who is not covered by HIPAA, it may be redisclosed and may no longer be protected by HIPAA.
I may refuse this authorization, and refusing will not affect payment or eligibility, except where the authorization is needed to provide the very care I am requesting.
I may inspect or obtain a copy of the information used or disclosed.
I may revoke this authorization at any time in writing to privacy@peptidesq.com or Privacy Officer, HC Smart, Inc. DBA PeptidesQ / MD Hotline, 20900 NE 30th Ave, Ste 200, Aventura, FL 33180. Revocation does not affect actions already taken before it was received.

If I was referred by a brand partner, I permit limited information (such as my name and dates of service or orders) to be shared with that partner for administrative purposes only — not for treatment and not as a sale of my personal data. I may revoke this at any time using the contact details above.

4. Compounded medications

The FDA does not approve or review compounded products for safety, effectiveness, or quality.
Compounding pharmacies are licensed and regulated by state and federal authorities and must follow strict quality-control standards.
My Provider and the dispensing pharmacy will give me safety and storage information for anything prescribed.

5. Peptide therapy

Peptides are short chains of amino acids that bind to cell receptors and act as signaling molecules, prompting cells to carry out specific functions. Peptide protocols aim to help prevent, reduce, or manage dysfunctions associated with aging, metabolism, recovery, and overall wellness. I understand that parts of the mainstream medical community and the FDA may regard these therapies as new, unproven, or controversial.

Goals

Each peptide works differently. My Provider will share information about my specific protocol, which supplements this consent.

Risks

At recommended doses, serious reactions are uncommon. Common side effects include redness, pain, or swelling at the injection site and facial flushing. Less frequently, people report dizziness, headache, palpitations, or restlessness, which usually resolve when the peptide is stopped. Allergic reactions can occur in sensitive individuals. I will report any side effect to my Provider right away.

Contraindications

Many peptides should not be used by people with active cancer or a history of certain cancers, or during pregnancy or breastfeeding. Other precautions may apply to me and will be discussed with my Provider.

My acknowledgements

I have enough information about the goals and risks to decide to start treatment, and my Provider will monitor me but cannot guarantee I will have no side effects or achieve satisfactory results.
This therapy does not prevent me from using other treatments.
Compounded peptides are not FDA-approved for any particular use, and insurers are likely to treat them as experimental or investigational and deny reimbursement.
I have had the opportunity to ask questions, and they have been answered to my satisfaction.
I have disclosed all known allergies, past reactions to injections, and all current medications and supplements.

6. Weight-loss programs

Members prescribed GLP-1 or similar medications for weight loss are provided the Florida Weight-Loss Consumer Bill of Rights. In summary:

Warning: rapid weight loss may cause serious health problems. Rapid weight loss is losing more than 1½ to 2 pounds per week, or more than 1 percent of body weight per week after the second week of a program.
Consult your personal physician before starting any weight-loss program.
Only permanent lifestyle changes, such as healthy food choices and more physical activity, promote long-term weight loss.
Qualifications of the provider are available on request.

You have the right to ask about the program's health risks, nutrition, psychological support, and educational components; to receive an itemized statement of the actual or estimated price, including extra products, services, supplements, exams, and lab tests; to know the expected duration; and to know the name, address, and qualifications of the dietitian or nutritionist who reviewed the program, as required by section 468.505(1)(j), Florida Statutes. New York residents have similar rights under N.Y. Gen. Bus. Law § 642.

7. Laboratory products and services

Some protocols require lab work or an at-home specimen collection kit supplied by third-party laboratories. Neither PeptidesQ nor my Provider can guarantee the accuracy of these results. Tests can return false positive, false negative, or inconclusive results, and a kit failure or defect could affect my Provider's ability to diagnose or treat me.

8. Consent to phone, text, and email communication

I authorize PeptidesQ and the Practice to contact me by phone, SMS/text, or email at the contact information I provide for:

sign-in verification codes and account notices;
appointment, refill, and reassessment reminders;
prescription, fulfillment, and shipping updates;
messages about my care or payment for my care;
feedback requests and general health and wellness information.

I understand that:

some messages may be generated in part by automated systems or AI;
standard message and data rates may apply;
this authorization continues until I revoke it, and I may opt out at any time using the instructions in a message or by emailing inquiries@peptidesq.com;
text and email carry some risk of unauthorized access to health information, and I accept that risk.

9. State-specific disclosures

Depending on where you are located during your visit, the following additional rights apply:

Records to your primary care provider (including Alaska, Connecticut, New Hampshire, Ohio, South Carolina, and Texas): with your consent, your telehealth records may be shared with your primary care or treating provider. In Texas this occurs within 72 hours of your visit; in Kansas, a report is sent within three days of your consent. To request that we send your records, email inquiries@peptidesq.com.
Indiana: with your consent, your prescriber will notify your primary care provider of prescriptions issued, unless an exception under Indiana law applies.
New Jersey: you may request a copy of your records and have them forwarded to your providers; if you have no primary care provider, we can help you locate one near you.
District of Columbia and Georgia: you have been informed of alternate ways to reach a clinician for urgent matters and of follow-up instructions if emergent care is needed.
Rhode Island and Virginia: you have been informed of the security measures used (such as encryption and authentication) and the remaining privacy risks of electronic communication.
South Dakota: you have received information about the delivery model, treatment options, limitations, and the basis for your diagnosis.
Utah: you may access and amend information you provided, contact your provider for follow-up, obtain a copy of your telehealth record and consent, and request its transfer to another provider.
Vermont: you may request a consult with a distant-site provider, and asynchronous care does not prevent future real-time or in-person care.
California: information about payments from drug and device makers to physicians is available through the federal Open Payments database at openpaymentsdata.cms.gov.
Billing (New Jersey, New York, Rhode Island): you may request an itemized price list for laboratory services.

10. Complaints

Concerns about your care can be sent to inquiries@peptidesq.com. You may also file a formal complaint with the medical or nursing licensing board in the state where you received care — in Florida, the Florida Department of Health, Division of Medical Quality Assurance.

11. Right to withdraw

You may withdraw this consent at any time by notifying your Provider or emailing inquiries@peptidesq.com. Withdrawal does not affect care already provided or your right to in-person care from another provider.

12. Governing law

This consent is governed by the laws of the State of Florida, except where the law of the state in which you receive care requires otherwise. HC Smart, Inc. DBA PeptidesQ / MD Hotline is located at 20900 NE 30th Ave, Ste 200, Aventura, FL 33180.

By clicking "Accept," creating an account, or continuing an intake, you acknowledge that you have read and understood this consent and voluntarily agree to receive care via telehealth. Last updated: November 9, 2026.