Informed Consent for Telehealth
Effective November 5, 2026 · Fairline Health LLC, West Palm Beach, Florida
Draft. This document is under review by our healthcare attorney and will be finalized before we accept our first patient. Nothing here is a substitute for that review.
You accept this consent during the health assessment. It's reproduced here so you can read it before you start.
1. What telehealth is
Telehealth means your provider reviews your health information and communicates with you through this website, secure messaging and video, rather than in person. Your provider may decide that in-person care is needed and tell you so.
2. Who provides care
Care is provided by independent licensed providers through [MEDICAL GROUP NAME]. Each provider is licensed in the state where you are located at the time of care. Fairline Health LLC provides the platform only and does not practice medicine.
3. Benefits and risks
Telehealth is convenient and lets a provider review your case quickly. Its limits: the provider can't examine you physically, relies on the information you give, and technology can fail. Information you omit or misstate can lead to the wrong decision about your care.
4. Compounded medication
If prescribed, your medication is prepared by Olympia Pharmacy, a licensed compounding pharmacy. Compounded medications are not FDA-approved and have not been evaluated by the FDA for safety or effectiveness. Your provider will explain the risks and side effects of the medication prescribed. Common side effects include nausea, constipation and fatigue; stop and seek care right away for severe stomach pain, persistent vomiting, or signs of an allergic reaction.
5. Your responsibilities
Provide complete and accurate information. Complete your monthly check-ins. Use medication only as directed. Tell your provider about new symptoms, new medications, or pregnancy. Keep your regular doctor informed; we'll share your records with them at your request.
6. Emergencies
This service is not for emergencies. If you have a medical emergency, call 911 or go to the nearest emergency room.
7. Privacy
Your information is protected as described in our Privacy Policy and the Notice of Privacy Practices you receive in the portal.
8. Your right to withdraw
You may stop telehealth care at any time by cancelling in your portal or telling your provider. Withdrawing doesn't affect care you've already received.
9. State-specific terms
[State-specific consent language for Florida and each additional launch state will be inserted here on the attorney's review.]