Medical Consent

Last updated: April 2026

WE ARE NOT A REPLACEMENT FOR EMERGENCY MEDICAL SERVICES. IF YOU HAVE A MEDICAL EMERGENCY, SEEK EMERGENCY MEDICAL CARE IMMEDIATELY IN-PERSON OR DIAL 911 OR YOUR LOCAL EMERGENCY NUMBER.

We reserve the right to change these terms as required by law.

1. Telehealth Consent

Telehealth enables you to access health services via audio-video interfaces such as videoconferencing, with network security protocols protecting confidentiality.

Expected Benefits

• Improved access to weight management healthcare across distances
• More efficient medical evaluation and management
• Access to distant specialist expertise
• Maintained connections with established providers

Possible Risks

• Insufficient image resolution for proper medical decision-making
• Equipment delays or failures
• Rare security protocol breaches causing privacy violations
• Lack of complete medical records potentially causing drug interactions or allergic reactions

Patient Understanding

• Privacy laws apply equally to telehealth
• You have the right to withdraw consent without affecting future care
• You have the right to inspect and receive copies of records for reasonable fees
• Alternative weight management methods are available
• You are obligated to inform physicians of other healthcare providers
• No results are guaranteed despite anticipated benefits

2. HIPAA Consent

The Health Insurance Portability and Accountability Act (HIPAA) safeguards patient privacy. Our office policies include:

• Patient information is kept confidential except as necessary for services
• Information may be shared with healthcare providers, laboratories, and insurance payers as appropriate
• Records may temporarily remain in administrative areas accessible only to staff and third-party providers
• Appointment reminders may be sent via telephone, email, or U.S. mail
• Vendors with PHI access must comply with HIPAA confidentiality rules
• Government agencies and insurance payers may inspect offices and documents
• Confidential information will not be used for marketing or advertising
• Patient access to records is provided per state and federal laws
• Terms are subject to modification to better serve practice and patient needs

Your Rights

• Request restrictions on protected health information use
• Request policy changes regarding PHI handling
• Our office is not obligated to alter internal policies per individual requests

3. Financial Consent

By agreeing to these terms, you authorize ProMultis, LLC to:

• Maintain your credit card on file for service balances
• Submit orders and release necessary medical records
• Make invoice changes and debit accounts for services not covered by third-party credits
• Charge your credit card for unpaid balances
• Automatically charge for auto-renewing programs unless you explicitly request cancellation before processing

You certify that you are authorized to use the credit card on file and will not dispute legitimate charges.

4. Shipping Authorization

Prescription medications are dispensed per state and federal law with pharmacist approval and Medical Board compliance. By agreeing to these terms, you acknowledge:

• Medication dispensing occurs upon shipping sign-out, not upon delivery
• ProMultis, LLC is held harmless for shipping delays or errors
• You grant permission for medication shipment to your provided address or an alternative address given by you

5. Contact Us

If you have questions about this Medical Consent, please contact us:

ProMultis, LLC
Email: help@promultis.co
Website: promultis.co