Informed Consent for Telehealth Services

Last Updated: March 21, 2026

This Informed Consent for Telehealth Services ("Consent") describes the terms under which telehealth services are provided to you through the DirectGLP platform located at directglp.com (the "Site"). By using the Site and agreeing to receive telehealth services, you acknowledge that you have read, understand, and agree to the terms of this Consent.

What is Telehealth?

Telehealth involves the delivery of healthcare services using electronic communications, information technology, or other means between a healthcare provider and a patient who are not in the same physical location. Telehealth services provided through DirectGLP may include:

• Patient consultation, diagnosis, and treatment recommendations
• Prescription of medications, including GLP-1 receptor agonists, when clinically appropriate
• Asynchronous messaging between you and your healthcare provider
• Review of your medical history, photos, and health questionnaire responses
• Referral to in-person care when determined clinically necessary
• Follow-up consultations and ongoing treatment monitoring

Potential Benefits

Telehealth services may provide the following potential benefits:

• Increased access to healthcare providers without the need for in-person visits
• More convenient and flexible scheduling
• Reduced travel time and associated costs
• Timely access to medical evaluation and treatment
• Ongoing monitoring and support for your weight management program

Risks and Limitations

As with any medical service, there are potential risks and limitations associated with telehealth, including but not limited to:

• The inability of your provider to conduct a physical examination, which may limit the provider's ability to diagnose your condition compared to an in-person visit.
• The provider may not have access to your complete medical history, which could affect medical decision-making.
• Delays in evaluation and treatment due to deficiencies or failures of electronic equipment, internet connectivity, or other technology.
• Security risks related to the electronic transmission of your personal health information, despite reasonable safeguards being in place.
• In rare cases, information transmitted may be insufficient to allow for appropriate medical decision-making.
• The provider may determine that telehealth services are not appropriate for your condition and may recommend an in-person visit instead.

No guarantees or assurances are made regarding the results of any telehealth consultation. Your condition may not be cured or improved, and in some cases may get worse.

Your Responsibilities

By consenting to telehealth services, you agree to:

• Provide accurate, complete, and honest information about your medical history, current health conditions, medications, allergies, and any other relevant health information.
• Inform your provider of any changes in your health status or medications.
• Follow your provider's instructions and treatment plan, including medication usage, dosage, and follow-up appointments.
• Contact your provider if you experience any adverse reactions or side effects from prescribed medications.
• Understand that withholding or providing inaccurate information may result in harm, including serious injury or death.

Emergency Situations

DirectGLP providers do not address medical emergencies. Telehealth services are not a substitute for emergency medical care. If you believe you are experiencing a medical emergency, you should immediately:

• Call 911 or your local emergency number
• Go to the nearest emergency room
• Contact your local poison control center if applicable

Do not rely on DirectGLP for emergency medical needs.

Prescription Medications

If your provider determines that a prescription medication, including GLP-1 receptor agonists such as semaglutide or tirzepatide, is appropriate for you, you acknowledge the following:

• The decision to prescribe is made at the sole discretion of your healthcare provider based on clinical judgment.
• There is no guarantee that you will be prescribed any particular medication.
• You are responsible for understanding the risks, benefits, side effects, and contraindications of any prescribed medication.
• You must disclose all current medications to avoid potentially dangerous drug interactions.
• Medications will be dispensed by a licensed pharmacy and shipped to your designated address.

Privacy and Medical Records

All information shared during your telehealth consultation is part of your medical record. Federal and state law requires healthcare providers to protect the privacy and security of your health information. Your information will be handled in accordance with our Privacy Policy and applicable federal and state laws, including HIPAA where applicable.

Your patient-identifiable images or information from telehealth visits will not be shared with researchers or other entities without your express consent.

Your Rights

You have the right to:

• Withhold or withdraw your consent to telehealth services at any time without affecting your right to future care or treatment.
• Request a copy of your medical records.
• Seek care from a provider who offers in-person services as an alternative to telehealth.
• Ask questions about your diagnosis, treatment, and care at any time.
• Discontinue your telehealth consultation at any time.

To withdraw your consent to telehealth services, please contact us at [email protected].

State-Specific Disclosures

California

Medical doctors are licensed and regulated by the Medical Board of California. You may contact the Medical Board at (800) 633-2322 or www.mbc.ca.gov to file a complaint or check a physician's license status.

Florida

Florida law requires that you be informed of the following: You have the right to a face-to-face consultation with a physician or other healthcare practitioner who is able to provide the requested service. The Florida Board of Medicine can be contacted at (850) 245-4131.

Texas

Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, may be reported for investigation to: Texas Medical Board, Attention: Investigators, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, TX 78768-2018. Assistance in filing a complaint is available by calling 1-800-201-9353. For more information, visit www.tmb.state.tx.us.

Kansas

Questions and concerns regarding this professional practice may be directed to: Kansas State Board of Healing Arts, 800 SW Jackson, Lower Level-Suite A, Topeka, Kansas 66612, Phone: (785) 296-7413, Toll Free: 1(888) 886-7205.

Contact Us

If you have any questions about this Telehealth Consent, please contact us at [email protected] or call us at +1 (877) 691-4571.

DirectGLP
1645 Commerce Drive
Marquette, MI 49855