1. Introduction
PureForty provides telehealth services that connect you with licensed healthcare providers for evaluation and, where clinically appropriate, prescription of medication. This Telehealth Informed Consent ("Consent") describes the nature of those services, their known risks and limitations, your responsibilities as a patient, and your rights. By completing and submitting PureForty's health intake form, you are indicating that you have read, understood, and agreed to this Consent.
2. Nature of Telehealth Services
PureForty delivers care through asynchronous telehealth. This means your consultation does not happen in real time. Instead of a live video or phone call, you complete a secure health intake form that captures your medical history, current medications, and relevant health information. A licensed clinician then reviews your submitted information independently, on their schedule, and makes a clinical determination based on what you have provided.
Following their review, the clinician may follow up via secure message if they have questions or need clarification before making a prescribing decision. No in-person physical examination is performed at any stage of this process.
All communications related to your care are transmitted through encrypted, secure electronic systems that meet applicable federal and state privacy standards.
3. Risks and Limitations
Telehealth has inherent limitations compared to in-person clinical care. Before consenting, you should understand the following:
- Your clinician cannot perform a physical examination. Their assessment is based entirely on the information you provide in your intake form, including your self-reported medical history, current medications, and health conditions.
- Because no physical exam is performed, certain conditions may not be detectable through asynchronous telehealth alone. Your clinician may determine that an in-person evaluation is necessary before any prescribing decision can be made.
- If your clinician determines that in-person care is needed for your safety, or that your clinical situation is too complex for asynchronous assessment, they may decline to prescribe and will recommend that you seek care in person.
- Telehealth is not a substitute for emergency medical care. If you are experiencing a medical emergency, call 911 or go to your nearest emergency room immediately.
4. Benefits
Despite these limitations, telehealth offers meaningful advantages that make care more accessible:
- Convenient access to licensed clinicians without requiring travel, time off work, or extended wait times for an appointment.
- No office visit required. The entire process — from intake to prescription to delivery — is handled remotely.
- Timely response. Our clinical team aims to review your intake and issue a determination within 24 hours of submission on business days.
5. Privacy and Security
The health information you submit through PureForty's intake form is Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA) and applicable state privacy laws. We take this responsibility seriously.
Your information is transmitted using encrypted secure systems and is stored with administrative, technical, and physical safeguards in place. Access to your PHI is restricted to your treating clinician and, where necessary to fulfill your prescription, the compounding pharmacy dispensing your medication. Your information is not sold to or shared with advertisers, data brokers, or any non-clinical third parties.
For a complete description of how we collect, use, and protect your information, please review our Privacy Policy.
While we employ strong security measures, no electronic system is entirely immune to unauthorized access or transmission failure. By consenting to telehealth services, you acknowledge and accept this inherent risk.
6. Patient Responsibilities
For telehealth to be safe and effective, you must fulfill the following responsibilities:
- Provide accurate and complete health history. Answer all intake questions truthfully, including current and past medical conditions, surgeries, and relevant family history. Your clinician's assessment depends entirely on the information you submit.
- Disclose all current medications and supplements. This includes prescription drugs, over-the-counter medications, vitamins, and herbal supplements. Omitting medications can result in dangerous drug interactions.
- Disclose all relevant medical conditions. Do not omit conditions that may affect your eligibility for treatment, even if you believe they are unrelated.
- Contact us if your condition changes. If your health status changes materially after submitting your intake — including new diagnoses, new medications, or worsening symptoms — contact us immediately at support@pureforty.com before beginning or continuing treatment.
- Seek emergency care for any emergency. Do not contact PureForty in place of calling 911 or seeking in-person emergency care.
7. Emergency Procedures
PureForty's telehealth platform is not designed or staffed to handle medical emergencies. Response times for support inquiries are measured in hours, not minutes.
If you or someone near you is experiencing a medical emergency — including but not limited to chest pain, difficulty breathing, stroke symptoms, severe allergic reaction, or loss of consciousness — call 911 or go to your nearest emergency room immediately. Do not wait to contact PureForty.
PureForty cannot dispatch emergency services, cannot access real-time monitoring of your condition, and cannot provide emergency medical intervention of any kind.
8. Prescription Considerations
All prescribing decisions are made at the sole discretion of the licensed clinician who reviews your intake. PureForty does not direct, influence, or override clinicians' prescribing decisions. Clinicians exercise independent medical judgment in your best interest.
Not all patients who submit a health intake will be approved for medication. A clinician may decline to prescribe if:
- Your health history indicates a contraindication to the requested medication.
- Your submitted information is incomplete or raises clinical questions that require in-person evaluation to resolve.
- The clinician determines that the requested treatment is not appropriate for your clinical profile.
The clinician's determination is final. If you are not approved, you will receive a notification and will not be charged for medication. See our Refund Policy for details.
Compounded drug products are not FDA-approved and have not been evaluated for safety, effectiveness, or quality by the FDA.
9. Patient Rights
As a patient receiving telehealth services through PureForty, you have the following rights:
- The right to ask questions about this Consent, the nature of the telehealth service, or your treatment plan before, during, or after your consultation.
- The right to refuse treatment or withdraw from treatment at any point.
- The right to withdraw your consent to telehealth services at any time. Withdrawal takes effect going forward and does not affect care already provided.
- The right to have your health information protected in accordance with HIPAA and applicable state laws.
To withdraw your consent, contact us at support@pureforty.com. We will process your withdrawal and confirm in writing.
10. Technical Requirements
To use PureForty's telehealth services, you need:
- A device capable of connecting to the internet — smartphone, tablet, or computer.
- A valid email address that you check regularly. Clinical correspondence, including any follow-up from your clinician, will be sent to this address.
- A sufficiently stable internet connection to complete and submit a web form.
If you experience a technology barrier that prevents you from completing your intake or receiving correspondence, contact us at support@pureforty.com and we will do our best to assist.