Telehealth Informed Consent

Last updated: June 4, 2026

By using LegacyRX, you provide informed consent to receive healthcare services through telehealth. Please read the following carefully before proceeding.

What Telehealth Is

Telehealth involves the delivery of healthcare services using secure electronic communications - including online questionnaires, secure messaging, and, where required, audio or video consultation - between you and a licensed provider who may be in a different location.

Potential Benefits

Improved access to care; convenience; and timely evaluation and treatment by a licensed provider without an in-person visit.

Potential Risks

As with any healthcare service, telehealth has potential risks, including: information transmitted may not be sufficient to allow for appropriate decision-making by the provider; delays in evaluation or treatment could occur due to technology failures; and, in rare cases, security protocols could fail, causing a breach of privacy. A provider may determine that telehealth is not appropriate for your condition and recommend in-person care.

Your Acknowledgments and Consent

• I understand that I will be given information about treatments as applicable, including the benefits, risks, possible complications, and alternatives to my care delivered through telehealth.
• I expressly consent to LegacyRX and its affiliated providers obtaining, using, storing, and disclosing my information to necessary third parties as needed to provide the Services and as described in the Privacy Policy and HIPAA Notice.
• I understand that the health information I provide may be the only source of health information used by the provider during my evaluation, and I agree to provide accurate and complete information.
• I understand that a prescription is not guaranteed and is issued only if a licensed provider determines it is clinically appropriate.
• I release and hold harmless LegacyRX and my care team from any loss of data or information arising from technical failures associated with the telehealth service.
• I have the right to withhold or withdraw consent to telehealth at any time and to seek traditional in-person care, without affecting my right to future care or benefits.
• I consent to the use of telehealth in the provision of my care and to the terms above.