Telehealth Informed Consent

Last updated on Nov 6, 2023. is owned by NEPHROGENX LIMITED LIABILITY COMPANY whose medical providers utilize the platform for rendering their medical services.


I understand that I should not use this service in a medical emergency, rather I should obtain medical care by calling 9-1-1 or going to a nearby emergency department.

What is Telehealth?

Telehealth is a way for you to receive medical care from a licensed healthcare provider while you and your provider are at different locations.

Potential Benefits

You may be able to access care which is difficult to find locally.

Potential Risks

Your provider is depending on you to provide honest and complete answers so they can provide you with the best possible medical care. The provider will not be able to independently verify the information you provide, so incomplete or dishonest answers could increase your risk when using this service.

Your provider will not be able to examine you as closely as an in-person provider can.

Technical issues may disrupt the telehealth services.

The security protecting the data you share via telehealth could be breached.

There may be other or unknown risks of using these telehealth services.

When responsibility for care and a health care provider-patient relationship is established

I understand that the licensed medical provider will take responsibility for my care only after I have answered all the required health questions, made a payment for the service, and the provider has had a chance to determine whether I am a good candidate for the telehealth services. I understand that if the provider accepts my request for medical care, at that point a health care provider-patient relationship will be established.

I understand that the licensed medical provider has the right to decline responsibility for my care if in their professional judgement I am not a good candidate for this service.

Conditions for Receiving a Refund

I understand that the consultation fee will be refunded if the provider declines responsibility for my care.

Ivermectin Treatment Informed Consent

I understand that Ivermectin received full FDA approval in 1996 for the treatment of strongyloidiasis and onchocerciasis and may now be legally prescribed for off-label treatments, such as the CDC recommending ivermectin as an off-label treatment for scabies [].

I understand the FDA has issued a notice stating Ivermectin should not be used to prevent or treat covid-19 [], describing these risks: “Even the levels of ivermectin for approved human uses can interact with other medications, like blood-thinners. You can also overdose on ivermectin, which can cause nausea, vomiting, diarrhea, hypotension (low blood pressure), allergic reactions (itching and hives), dizziness, ataxia (problems with balance), seizures, coma and even death.” Further, in this notice the FDA states: “If your health care provider writes you an ivermectin prescription, fill it through a legitimate source such as a pharmacy, and take it exactly as prescribed.”

While the National Institute of Health (NIH) is running the Active-6 trial ( to determine if Ivermectin is helpful for treating covid-19, this trial is not expected to be completed until March of 2023 []. I understand I may be eligible to provide voluntary consent to participate in an RCT clinical trial of Ivermectin for covid-19 however such consent would necessitate accepting the risk involved with an active treatment of ivermectin as well as the risk of a placebo treatment for covid-19. By electing to take FDA approved ivermectin under the care of a medical provider, I voluntarily choose to remove the risk of receiving a placebo as a treatment for Covid-19, which would occur if I provided voluntary consent to participate in an RCT trial of Ivermectin for Covid-19.

Additional State-Specific Disclosures

The following disclosures apply to users accessing the platform for the purposes of participating in telehealth as required by the states listed below:

I have been informed to register a formal complaint about a provider, I should visit the medical board’s website for the following states:

for Iowa-,

for Kentucky-,

for Maine-,

for Oregon-,

for Rhode Island-,

for Vermont –; or Board of Osteopathic Examiners can be found at:,

for Wyoming-

For New York: I have been informed that to get information regarding your rights and how to report professional misconduct, I should visit, here:

For Texas: I have been informed of the following notice:

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, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353, For more information, please visit our website at

AVISO SOBRE LAS QUEJAS- Las quejas sobre médicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353, Para obtener más información, visite nuestro sitio web en