The purpose of this Telehealth Acknowledgment and Informed Consent ("Consent") is to give you information about telehealth and to obtain your informed consent to receive healthcare services by telehealth from the physicians, nurse practitioners, physician assistants, and other licensed clinicians ("Providers") who deliver care through the Celara Med platform (the "Service"). Please read it carefully before receiving services.
Celara Med LLC provides the technology platform, scheduling, customer support, billing, and administrative services that support the Service. Celara Med LLC does not practice medicine and does not make clinical decisions about your care. Providers are licensed independently and exercise their own professional judgment. Your Provider, not Celara Med, is responsible for your medical care.
Celara Med Does Not Practice Medicine
Celara Med LLC is a technology and administrative services company. Celara Med LLC is not a medical practice, is not a healthcare provider, and is not a pharmacy. Celara Med LLC does not practice medicine, does not diagnose conditions, does not prescribe or dispense medication, does not determine medical eligibility, and does not make or influence any clinical decision about your care.
All medical evaluation, diagnosis, prescribing, and treatment decisions are made solely by licensed healthcare professionals who exercise independent professional judgment. Those Providers are not employed, supervised, directed, or controlled by Celara Med LLC in their clinical work. Dispensing is performed by independent licensed pharmacies.
Nothing in this Consent, on the Celara Med website, or in any Celara Med communication should be understood as medical advice from Celara Med LLC. If a Celara Med employee, contractor, Brand Partner, or customer support representative offers you an opinion about your health, treatment, dosage, or eligibility, that opinion is not medical advice and should not be relied on. Direct all clinical questions to your Provider.
Additional Consents From Provider Networks
Depending on the service you request and the provider network that evaluates you, you may be asked to review and accept an additional consent, intake authorization, privacy notice, or other clinical documentation presented by that network or by the Provider directly. That may occur at checkout, during intake, or before your evaluation begins.
Where a Provider or provider network presents its own informed consent, that document governs the clinical relationship between you and that Provider. This Consent continues to apply to your use of the Celara Med platform and to the matters described in it that the other document does not address.
Where a Provider or provider network does not present a separate telehealth consent, this Consent serves as your informed consent to receive care by telehealth from the Providers who evaluate and treat you through the Service.
If you are asked to accept more than one consent and they appear to conflict on a clinical matter, the consent provided by your treating Provider or their network controls as to that matter. If you are unsure which document applies to you, contact support@celaramed.com before proceeding.
Emergency Care
TELEHEALTH IS NOT FOR EMERGENCIES. If you are experiencing a medical emergency, call 911 or go to the nearest emergency department immediately. Do not use this platform, messaging, or customer support for urgent or emergency medical needs.
Telehealth services are not monitored continuously and responses are not immediate. If your condition worsens, if you experience a severe reaction to a medication, or if you have any symptom that concerns you, seek in-person care rather than waiting for a response through the platform.
What Telehealth Is
Telehealth is the delivery of healthcare services using electronic communications when you and your Provider are not in the same physical location. Depending on your care, telehealth may involve secure messaging, written intake questionnaires, photographs you submit, video visits, telephone calls, laboratory results, identity verification, and review of the medical history you provide.
Your Provider will determine which method of evaluation is appropriate for your situation and may require a synchronous video or telephone visit before making or continuing a treatment decision.
Potential Benefits
Telehealth may allow you to receive care without traveling to an office, may reduce wait times, may provide access to providers who are not available locally, and may allow more flexible scheduling and follow-up.
Potential Risks and Limitations
You should understand the following before consenting to telehealth:
A remote evaluation does not include a hands-on physical examination. Information that a Provider would obtain by examining you in person may be unavailable, and a condition that would be detected during an in-person visit may go undetected.
Your Provider relies substantially on the accuracy and completeness of the information you supply. Incomplete or inaccurate information may lead to an inappropriate treatment decision, a delay in diagnosis, or a recommendation that is not right for you.
Electronic transmission can fail. Images may be of insufficient quality, connections may drop, messages may be delayed, and technical problems may interrupt or delay care.
Despite reasonable security measures, no electronic system is completely secure. There is a risk, though it is intended to be small, that information transmitted electronically could be intercepted or accessed without authorization.
Telehealth is not appropriate for every condition. Your Provider may determine that your situation requires in-person evaluation, laboratory testing, imaging, or referral, and may decline to treat you through telehealth.
As with any medical treatment, there are risks associated with any medication or therapy that may be prescribed, including side effects and adverse reactions. Your Provider will discuss the risks relevant to any treatment recommended for you.
Your Alternatives
You are not required to use telehealth. You may seek in-person care from a healthcare provider of your choosing at any time, and you may request in-person care instead of or in addition to telehealth. Choosing telehealth does not limit your right to seek care elsewhere.
No Guaranteed Outcome or Prescription
Submitting an intake form, completing a purchase, or requesting a particular medication does not create an entitlement to a prescription. Your Provider will prescribe only what they determine to be medically appropriate for you, and may decline to prescribe, prescribe something different, require additional information or testing, or determine that treatment is not appropriate.
No specific clinical result, weight-loss result, symptom improvement, or other outcome is promised or guaranteed.
Your Provider's Credentials
The name and credentials of the licensed professional responsible for your care are made available to you through the platform before and during your care. If you have questions about your Provider's licensure, training, or qualifications, you may ask your Provider directly or contact support@celaramed.com, and the information will be provided to you.
Providers are licensed in the state in which you are located at the time of service. Depending on your care, your Provider may be a physician, a nurse practitioner, or a physician assistant. By consenting, you agree to be evaluated and treated by a non-physician licensed professional where that is appropriate and permitted in your state.
Who May Be Present
In some cases, personnel other than your Provider may be involved in a telehealth encounter in order to operate the technology or support the visit. You will be informed if another person is present.
You have the right to ask that non-medical personnel leave the encounter, to omit details of your medical history that are personally sensitive to you, and to end the encounter at any time.
Consultation and Coordination
Your Provider may consult with other licensed professionals about your care in order to improve the quality of the evaluation or treatment you receive. Anyone involved in that consultation is bound by the same confidentiality obligations that apply to your Provider.
Telehealth through this platform does not replace a relationship with a primary care provider. You are encouraged to maintain one, and to share information about treatment received here with your other treating providers.
Controlled Substances
Some medications available through the Service, including testosterone and other testosterone-containing hormone therapy, are federally controlled substances. Prescribing a controlled substance by telehealth is subject to federal law and to the law of your state, which may require a synchronous video or telephone evaluation, an in-person examination before or during treatment, periodic re-evaluation, or additional documentation.
Your Provider will tell you what your state requires and will not prescribe a controlled substance unless those requirements are met. If your state requires an in-person examination that this Service cannot provide, your Provider will tell you and you will need to obtain that examination elsewhere before treatment can begin or continue.
Federal and state rules governing telehealth prescribing of controlled substances change. A change in those rules may require an additional visit, an in-person examination, or an interruption in treatment. Celara Med and your Provider will notify you if that occurs.
Laboratory Testing
Your Provider may determine that laboratory testing is necessary before or during treatment. Testing may be performed through an at-home collection kit or at a collection site, and is performed by independent laboratories. Neither Celara Med nor your Provider performs the testing or guarantees the accuracy or reliability of a third-party laboratory result.
Laboratory tests can produce false negative, false positive, or inconclusive results, and a failed or defective test could affect your Provider's ability to evaluate or treat you correctly. Blood collection carries ordinary risks including discomfort, bruising, bleeding, lightheadedness, and rarely infection at the collection site.
Laboratory testing is voluntary. You may decline testing, though your Provider may decline to prescribe or continue treatment without it. You are responsible for sharing results with your primary care provider and for arranging any follow-up those results warrant.
Technology Failures
Telehealth depends on electronic systems that can fail. Connections may drop, images may be of insufficient quality, messages may be delayed, and equipment may malfunction. Any of these may delay evaluation or treatment, and in some cases may require a visit to be rescheduled or redirected to in-person care.
To the extent permitted by law, you agree not to hold Celara Med or your Provider responsible for delays in evaluation or for information lost as a result of a technical failure outside their reasonable control. This does not limit any responsibility a Provider has for the professional care they deliver.
Compounded Medications
Some medications available through the Service are compounded. A compounded medication is prepared by a licensed pharmacy for an individual patient. Compounded medications are not FDA-approved. The FDA does not review compounded drugs for safety, effectiveness, or manufacturing quality before they are dispensed, and compounded versions of a medication may differ from the FDA-approved version in formulation, strength, inactive ingredients, or route of administration.
Your Provider will tell you if a medication being considered for you is compounded, and will discuss the reason for using a compounded preparation rather than an FDA-approved product. You may ask questions about the compounding pharmacy, the formulation, and the alternatives available to you, including FDA-approved products, before deciding whether to proceed.
Adverse events, unexpected reactions, and quality concerns should be reported to your Provider promptly and may also be reported to the FDA MedWatch program.
Asynchronous Care and Your Provider's Determination
Some evaluations through the Service are conducted asynchronously, meaning your Provider reviews the information you submit, including your intake questionnaire, medical history, photographs, and any laboratory results, without a live visit occurring at the same time.
Your Provider reviews your information and determines whether the same standard of care that would apply to an in-person visit can be met asynchronously in your situation. If your Provider determines that it cannot, or if the law of your state requires it, you will be asked to complete a live video or telephone visit before treatment can be prescribed or continued.
You may request a live visit at any time, whether or not one is required.
Your Responsibilities as a Patient
You agree to provide information about your health, medications, allergies, medical history, symptoms, and identity that is truthful and complete to the best of your knowledge, and to promptly inform your Provider of any material change in your health or medication use.
You agree to follow the instructions given by your Provider and by the dispensing pharmacy, and not to alter a prescribed dose, combine medications, or discontinue treatment without consulting your Provider.
You agree to respond to reasonable requests from your Provider or pharmacy for additional information, laboratory testing, identity verification, or follow-up. Failure to respond may delay or prevent treatment.
You confirm that you are physically located in a state where your Provider is licensed at the time services are provided, and you agree to inform us if your location changes.
Medical Records and Confidentiality
Information you provide during telehealth becomes part of your medical record and is protected by applicable federal and state health privacy laws, including the Health Insurance Portability and Accountability Act where it applies.
Your health information may be shared with the licensed professionals involved in your care, with dispensing pharmacies, with laboratories, and with service providers acting on the Practice's behalf under appropriate agreements. It may also be disclosed where required or permitted by law.
You have the right to request access to your medical record and to request an amendment, in accordance with applicable law and your Provider's Notice of Privacy Practices.
You have the right to request that a copy of the record of your telehealth encounter be provided to you, or forwarded to your primary care provider or another treating provider you identify. Reasonable costs of preparation and delivery may apply where permitted by law.
You may request an in-person consultation instead of, or in addition to, telehealth at any time. If in-person care is not available through this platform, you will be told so and you remain free to seek it elsewhere.
Confidentiality has limits. Your information may be disclosed without your authorization where the law requires or permits it, including where there is a threat of serious harm to you or another person, where abuse or neglect of a child or a dependent or elderly adult is reasonably suspected, in response to a court order or subpoena, during clinical supervision or consultation, and for treatment, payment, and healthcare operations.
Recording
Providers do not record telehealth visits without your knowledge. If a visit is to be recorded, you will be informed in advance and asked for consent where required by law.
You may not record a telehealth visit without the express permission of your Provider. Recording a clinical encounter without consent may violate state law.
Fees and Payment
Services accessed through this platform are generally provided on a cash-pay basis and are not billed to Medicare, Medicaid, or commercial insurance unless expressly stated otherwise. You are responsible for the fees disclosed at the time of purchase, and payment does not guarantee that a prescription will be issued.
Follow-Up and Continuity of Care
Telehealth through this platform may not constitute a complete or ongoing primary care relationship. You are encouraged to maintain a relationship with a primary care provider and to share information about treatment received here with your other healthcare providers.
If you stop using this service, you remain responsible for arranging appropriate ongoing care, including any monitoring a medication may require.
Withdrawing Consent
Your consent is voluntary. You may withdraw it at any time, without affecting your right to future care, by notifying your Provider in writing. Withdrawal applies going forward and does not affect services already provided.
Questions and Concerns
Clinical questions about your treatment should be directed to your Provider through the platform's clinical messaging channel rather than to general customer support.
If you have a concern about the care you received, you may raise it with us. You also retain the right to contact the medical licensing board in your state.
Business Relationships and Your Right to Choose
Celara Med has a financial relationship with the professional entity that employs or contracts with your Provider, and with the pharmacies and laboratories that fulfill orders placed through the Service. These relationships are disclosed so that you can make an informed decision about your care.
You are free to obtain a medical examination from any healthcare provider you choose, including a provider who is not associated with Celara Med.
You are free to have any prescription filled at a pharmacy of your choice. If you would prefer a pharmacy other than one used by the Service, contact customer support and your prescription can be sent there instead. Prescriptions may be filled by, and transferred among, the pharmacies that work with the Service.
Compensation paid to Celara Med is for technology, marketing, and administrative services. It is not payment for the referral of patients or for the issuance of any prescription.
Notice to California Patients
Physicians and surgeons are licensed and regulated by the Medical Board of California. To verify a license or file a complaint, visit www.mbc.ca.gov or call (800) 633-2322.
State-Specific Disclosures
Some states require additional disclosures. The disclosures below apply based on the state in which you are located at the time you receive services. Where a state requirement conflicts with anything else in this Consent, the state requirement controls for patients in that state.
Florida: Weight-Loss Consumer Bill of Rights
If you are located in Florida and are receiving weight-loss services or products, including a prescribed GLP-1 medication for weight loss, the following notice is provided to you under Florida Statutes section 501.0575:
WARNING: RAPID WEIGHT LOSS MAY CAUSE SERIOUS HEALTH PROBLEMS. RAPID WEIGHT LOSS IS WEIGHT LOSS OF MORE THAN 1 1/2 POUNDS TO 2 POUNDS PER WEEK OR WEIGHT LOSS OF MORE THAN 1 PERCENT OF BODY WEIGHT PER WEEK AFTER THE SECOND WEEK OF PARTICIPATION IN A WEIGHT-LOSS PROGRAM.
CONSULT YOUR PERSONAL PHYSICIAN BEFORE STARTING ANY WEIGHT-LOSS PROGRAM.
ONLY PERMANENT LIFESTYLE CHANGES, SUCH AS MAKING HEALTHFUL FOOD CHOICES AND INCREASING PHYSICAL ACTIVITY, PROMOTE LONG-TERM WEIGHT LOSS.
QUALIFICATIONS OF THIS PROVIDER ARE AVAILABLE UPON REQUEST.
YOU HAVE THE RIGHT TO: (1) ASK QUESTIONS ABOUT THE POTENTIAL HEALTH RISKS OF THIS PROGRAM AND ITS NUTRITIONAL CONTENT, PSYCHOLOGICAL SUPPORT, AND EDUCATIONAL COMPONENTS; (2) RECEIVE AN ITEMIZED STATEMENT OF THE ACTUAL OR ESTIMATED PRICE OF THE WEIGHT-LOSS PROGRAM, INCLUDING EXTRA PRODUCTS, SERVICES, SUPPLEMENTS, EXAMINATIONS, AND LABORATORY TESTS; (3) KNOW THE ACTUAL OR ESTIMATED DURATION OF THE PROGRAM; AND (4) KNOW THE NAME, ADDRESS, AND QUALIFICATIONS OF THE DIETITIAN OR NUTRITIONIST WHO HAS REVIEWED AND APPROVED THE WEIGHT-LOSS PROGRAM ACCORDING TO SECTION 468.505(1)(j), FLORIDA STATUTES.
To request an itemized cost statement, program duration information, or provider qualifications, contact support@celaramed.com.
New York: Weight Loss and Dieting Information
If you are located in New York and are purchasing weight loss services or products, including a prescribed GLP-1 medication for weight loss, the following notice is provided to you under New York General Business Law section 642:
WARNING! Rapid weight loss may cause serious health problems. Rapid weight loss is weight loss of more than 1 1/2 to 2 pounds per week or weight loss of more than 1 percent of body weight per week after the second week of participation in a weight loss program.
Consult your physician before starting any weight loss program or using any diet medications or formulas.
Long term weight control is the safest and most important goal of any diet program. Permanent lifestyle changes such as eating nutritious foods, calorie control and increasing physical activity help promote long term weight loss according to medical experts.
Ask the person providing or selling you weight loss advice or diet products, medications or formulas about their qualifications and training in nutrition and health.
You have the right to: (1) ask questions about the potential health risks of this program or product, its nutritional content, and its psychological-support and educational components; (2) know the price of treatment, including the price of any extra products, services, supplements and laboratory tests; and (3) know the program duration of the program recommended to you.
This notice is made available to you before purchase. To request pricing detail, program duration information, or provider qualifications, contact support@celaramed.com.
California
Physicians and surgeons are licensed and regulated by the Medical Board of California. To verify a license or file a complaint, visit www.mbc.ca.gov, email licensecheck@mbc.ca.gov, or call (800) 633-2322.
You have the right to withhold or withdraw your consent to the use of telehealth at any time without affecting your right to future care or treatment.
Texas
Texas law requires informed consent before telemedicine services are provided (Tex. Occ. Code sec. 111.002). By accepting this Consent you provide that consent.
If you consent and you have a primary care physician, your Provider will provide your primary care physician with a report of the telemedicine services within 72 hours after the encounter (Tex. Occ. Code sec. 111.005). Tell us your primary care physician's name and contact information if you would like that report sent, or contact support@celaramed.com to opt out.
Your Provider will also give you guidance on appropriate follow-up care.
NOTICE CONCERNING COMPLAINTS: Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants, may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 1801 Congress Avenue, Suite 9.200, P.O. Box 2018, Austin, Texas 78768-2018. Assistance in filing a complaint is available by calling 1-800-201-9353. For more information please visit www.tmb.state.tx.us.
AVISO SOBRE LAS QUEJAS: Las quejas sobre medicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Medico de Tejas, incluyendo asistentes de medicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente direccion para ser investigadas: Texas Medical Board, Attention: Investigations, 1801 Congress Avenue, Suite 9.200, P.O. Box 2018, Austin, Texas 78768-2018. Si necesita ayuda para presentar una queja, llame al 1-800-201-9353. Para obtener mas informacion, visite nuestro sitio web en www.tmb.state.tx.us.
Louisiana
Your Provider's name, Louisiana medical license number, area of practice, and contact information are made available to you through the Service and on request. Follow-up care and urgent concerns should be directed through the clinical messaging channel; in an emergency call 911 or go to the nearest emergency department.
You may obtain a copy of your medical record, or have it transmitted to another provider, by contacting support@celaramed.com. If a technology failure prevents your encounter from proceeding, contact support@celaramed.com and your visit will be rescheduled or redirected.
You are informed of the physician-patient relationship established through this Service and of the role of any other provider involved in your care. You may decline telemedicine and may withdraw from it at any time without affecting your right to future care. Celara Med's notice of privacy practices is available on request.
Nebraska
Before your first telehealth consultation you will be given written information about telehealth and asked to confirm, by signature or by verbal consent during the consultation, that the information was provided to you and discussed with you.
Patient-identifiable images or information from your telehealth consultation will not be disseminated to researchers or other entities without your written consent. You may refuse a telehealth consultation at any time without affecting your right to future care, and you may request an in-person consultation immediately after a telehealth consultation; if one is not available through this Service you will be told so.
Connecticut
At your first telehealth interaction, you are informed of the treatment methods and limitations of telehealth and asked for your consent, which is documented. If you later revoke your consent, that revocation is documented as well.
At your first interaction you will also be asked whether you consent to disclosure of your records to your primary care provider. If you consent, your records will be provided to that provider in a timely manner.
New Jersey
Your Provider's identity, professional credentials, and contact information are made available to you at the time of scheduling or on request. Your Provider will inform you at the outset whether your evaluation is being conducted asynchronously and whether the same standard of care can be met that way.
Your records will be made available to you on request and, with your affirmative consent, forwarded to your primary care provider. You will not be required to use telehealth in place of in-person care.
Prescribing of Schedule II controlled substances through telehealth is subject to New Jersey requirements including an initial in-person examination and periodic in-person visits. Your Provider will tell you if those requirements apply to you.
Indiana
Your Provider will identify themselves and disclose their licensure or certification, verify your identity and location, take a history, and discuss the evaluation, the basis for it, and the risks and benefits of treatment options including when in-person care is advisable.
With your consent, your Provider will notify your primary care provider of any prescription issued to you. You will receive a summary of your telehealth visit, including any prescription.
Please be aware that if another person is within hearing distance during your telehealth encounter, information discussed may not remain confidential as to that person.
Maryland
At your initial encounter you are given your Provider's name, contact information, license type, and specialty. Your Provider will confirm your identity and that you are located in Maryland, and will discuss the risks, benefits, and side effects of any treatment prescribed.
All individuals present at each location will be identified and confirmed as permitted to hear your health information. Data is transmitted using encryption, and you will be notified of any data breach affecting your information.
Vermont
Your consent includes an explanation of the opportunities and limitations of telehealth. If any other individual will participate in or observe your consultation, you will be told and your permission will be requested. Services are delivered over a secure, HIPAA-compliant connection.
Telemedicine and telephone consultations are not recorded.
New Hampshire
You are provided your Provider's name, contact information, and license type. Subject to your consent, your Provider will forward your medical record to your primary care provider or other treating provider.
Telehealth prescribing of a controlled substance in New Hampshire requires a subsequent evaluation not less than annually. Your Provider will tell you if this applies to your treatment.
Arizona, Idaho, Michigan, Ohio, and Alabama
Consent to telehealth is obtained and documented before services are provided. Your identity, your physical location, and your Provider's identity and credentials are verified and recorded. You are informed of the security measures used to protect your information and of the risk that a technical failure could delay care or result in loss of information.
Delaware and Oklahoma
In these states your consent to telehealth is obtained in writing before the provider-patient relationship is established. Your written consent acknowledges the risks of electronic communication, the possibility of a confidentiality breach despite security measures, and the possibility that a connection may be disrupted.
All Other States
Requirements vary by state, and some states mandate disclosures beyond those set out above. Regardless of where you are located, and to the fullest extent the law of your state allows, the following apply to your care through this platform:
You may request that the record of your telehealth encounter be sent to your primary care provider or another treating provider, and it will be sent.
You may request an in-person consultation, and you will be told promptly whether one is available through this platform or whether you will need to seek it elsewhere.
You may obtain a copy of your medical record, including the consent you provided, and may request that it be transferred to another provider.
You may withdraw your consent to telehealth at any time without affecting your right to future care.
You may direct a concern or complaint about your care to the medical licensing board in your state. Contact information for your state's board will be provided on request.
If your state requires a disclosure that is not set out in this Consent, that disclosure will be provided to you on request and before services continue. To request the disclosures applicable in your state, contact support@celaramed.com.
Acknowledgment and Consent
By checking the acceptance box, electronically signing, or proceeding with a telehealth service, you acknowledge and agree that:
You have read and understand this Consent, and you have had the opportunity to ask questions about telehealth and about your care.
You understand the benefits, risks, and limitations of telehealth described above, and you understand that in-person care is available to you as an alternative.
You understand that Celara Med LLC provides technology and administrative services only, and that your Provider, not Celara Med LLC, is responsible for your medical care.
You understand that no specific outcome or prescription is guaranteed.
You are at least 18 years of age and legally able to consent to your own medical care.
You voluntarily consent to receive healthcare services through telehealth from the licensed professionals who deliver care through the Service.