Telehealth Consent (Menopause & Weight Loss)

Privacy and SecurityImportant Disclosures by StateCancellation & Refund PolicyPartner Policies

IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, PLEASE CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM IMMEDIATELY. OUR TELEHEALTH SERVICES ARE NOT INTENDED FOR EMERGENCY CARE.

We reserve the right to update these terms at any time as required by law. Changes may involve additions, removals, or modifications, and can be made due to legal obligations, business needs, industry shifts, or other relevant factors

Introduction

Telehealth allows you to consult with licensed healthcare professionals remotely through secure audio, video, and digital communications. By submitting the intake form (or proceeding with a virtual visit), you consent to receive non-emergency care and wellness services from medical providers through telehealth technology on the Intimate Rose platform.

Our telehealth services are intended for adults seeking non-emergency care.

What You’re Agreeing To

By submitting the intake form (or by proceeding with a virtual visit), you acknowledge that you:

  • Understand telehealth involves consultations where your provider is not physically present.
  • Consent to allow your provider access to relevant health records, including prescriptions.
  • Will be in a private location during the visit and understand your provider will be as well.
  • Are aware of potential technology-related risks like interruptions or unauthorized access.
  • Understand a telehealth provider may be a nurse practitioner or physician assistant.
  • Know that telehealth may not be suitable for all conditions and you may be referred elsewhere.
  • Agree that providing accurate and complete information is your responsibility.
  • Understand that a prescription is not guaranteed and will be at the provider’s discretion.
  • I understand that while the platform may make available access to certain pharmacy or diagnostic lab services, I may request to use any pharmacy or lab of my preference.
  • I understand that providers do not address medical emergencies via the platform. I understand that the responsibility of my provider may be to direct me to emergency medical services, such as an emergency room.
  • Are responsible for any charges related to your telehealth visit.

Additional Treatment-Specific Consent (Compounded Medications)

The following consent applies to patients who receive a prescription from a provider for compounded medications.

  1. I understand that the FDA does not approve nor review compounded products for safety, effectiveness, or quality.
  2. I understand that compounding pharmacies must adhere to strict quality control standards to ensure the safety and effectiveness of the medications they prepare. Compounding pharmacies are licensed pharmacies subject to state and federal regulations.
  3. I agree to only obtain weight loss medication through this platform moving forward.
  4. For more safety information about prescribed medications please contact us  rx@intimaterose.com

Privacy and Security

I understand and agree that I give permission to providers to use and disclose my protected health information including my entire medical record. This protected health information is being used or disclosed for the purpose of telehealth treatment. This authorization expires when you contact rx@intimaterose.com.

  1. If the person or entity receiving this information is not a health care provider or health plan covered by HIPAA, the information described above may be redisclosed to other individuals or institutions and therefore no longer protected by HIPAA.
  2. I may refuse to agree to this authorization. My refusal to sign will not affect my payment, ability to obtain treatment, or eligibility for health plan benefits unless this authorization is requested prior to research related to treatment, enrollment in a health plan, or providing health care that is solely for the purpose of giving that information to a third party, such as to a court for a legal proceeding.
  3. I may inspect or copy the protected health information to be used or disclosed under this authorization. For protected health information created as part of a clinical trial, your right to access is suspended until the clinical trial is completed.
  4. I may revoke this authorization in writing at any time by sending a written notification to Privacy Officer at 1419 Murray St. North Kansas City 64116. Your notice of revocation will not apply to actions taken by providers prior to the date of receipt of the notice.

Your privacy is important to us. By using our telehealth service, you consent to the use and sharing of your health information for treatment purposes in accordance with applicable privacy laws. Communications via text or email (if enabled) are not considered secure, and you accept the risk of receiving non-sensitive information through those channels.

Technical Issues

You understand that telehealth relies on internet and communication technologies that may occasionally fail. In the event of a service interruption, your provider will make reasonable efforts to reconnect, but care may need to be rescheduled or transitioned to an alternative method.

Important Disclosures by State

If you're located in the following states, you should be aware of the following laws and rights related to telehealth:

  • Alaska, Connecticut, Ohio, New Hampshire, South Carolina: Your primary care provider may request and receive a copy of your telehealth treatment record with your consent.
  • California: You can learn more about the Physician Payments Sunshine Act at https://openpaymentsdata.cms.gov.
  • Kansas: Providers must send a report to your primary care doctor within 3 days of your consent.
  • New Jersey: You have the right to request a copy of your medical information, and it may be forwarded to your doctor.
  • Texas: With your consent, your medical records may be sent to your primary care provider within 72 hours.

If you have any questions before continuing, please contact our support team or speak with your provider directly. We're here to help you feel confident and supported in your care journey.

By continuing, you confirm that you understand the above and voluntarily consent to receive telehealth services through Intimate Rose.

Cancellation & Refund Policy

We aim to make things simple and transparent. Because medical care and pharmacy resources are committed as soon as you begin, cancellations and refunds work as follows:

Subscription Services

  • Your membership in the subscription program ("Subscription Service"), including your ability to access the services, begins when you have completed the intake form, at which time you will be charged for the first month of the Subscription Services.
  • The Subscription Services include access to providers, medications where appropriate, and online support.
  • Please note that if you are disqualified by our medical provider for any medical reason, you will receive a full refund.
  • There is no guarantee of results or effectiveness due to your participation in the Subscription Services.

Cancellation Policy

  • You may cancel your Subscription Service at any time for any reason. To cancel, please contact customer service or through the process outlined in your online account (if applicable).
  • To ensure a smooth process, we require your cancellation request to be received at least 72 hours prior to your billing date. If this notice is not met, your subscription will be charged on the next billing date and the cancellation will take effect on the subsequent billing date.
  • After cancellation, you will continue to receive the Subscription Services through the end of your billing cycle.
  • Please see our Refund Policy below to determine if you are eligible for a refund.

Refund Policy

Refunds are only offered in limited cases:

  • Medical Disqualification – If our licensed provider determines you are not medically eligible for treatment, you will receive a full refund. If a refund is approved, it will apply to your most recent billing cycle only and will not be issued for past billing cycles.
  • Prepaid Subscription Bundles (Multi-Month Prepaid Discounted Plans) – If a provider determines you are not medically eligible for treatment, any unused prepaid months will be refunded in full. Refunds for prepaid bundles are not available once care has begun, except in cases of medical disqualification.
  • Billing Error – If a duplicate or incorrect charge occurs, please contact customer service and we will resolve it promptly.
  • Pharmacy/Shipping Delay – If your medication hasn't shipped within 21 days of provider approval, please contact customer service to review your case.
  • Damaged or Incorrect Items – Please inspect your medication immediately upon receipt. Damaged items: May be replaced by the pharmacy upon receipt of evidence of damage. Incorrect items: Incorrect medications will be replaced by the pharmacy.

Please note that federal law generally prohibits the return of prescription medications once they have been dispensed, in order to protect public health and safety.

Refunds are not available once your intake form is submitted (unless medically disqualified), after medication has shipped, or once a subscription renewal has been processed.

Questions? If you have questions about an eligibility-initiated cancellation or any charges, please contact our customer service team at rx@intimaterose.com.

Third-Party Partners

Certain telehealth services offered through Intimate Rose are provided by independent, third-party licensed medical providers and pharmacies (collectively, “Providers”). Intimate Rose does not practice medicine, provide medical services, or dispense prescription medication. All medical advice, diagnoses, prescriptions, and treatment decisions are the sole responsibility of the Providers.By using these services, you acknowledge and agree that:

  1. Separate Terms Apply – Your use of telehealth services is subject to the Providers’ own Terms & Conditions and Privacy Policies, which are in addition to these Intimate Rose Terms. You must review and agree to those policies before receiving care.
  2. Scope of Responsibility – Intimate Rose’s role is limited to providing access to the platform, educational resources, and customer support. We are not responsible for medical advice, clinical outcomes, or the availability of prescribed medications.
  3. Liability Disclaimer – Intimate Rose disclaims all liability for medical services, prescriptions, or treatment outcomes provided by third-party Providers. Your medical relationship is solely between you and the Provider.

By proceeding, you confirm that you understand and agree to both these Intimate Rose Terms & Conditions and the applicable Providers’ Terms & Conditions as noted below.

OpenLoop Health

Subscription Services FAQs

What is included in my Subscription Services price?
Your Subscription Services represents a single price for the subscription purchased. This may include consultations (both live and via electronic form submissions), provider reviews, medications fulfilled through a pharmacy, lab services, care support, a 24/7 patient support line, and other services to support your medical journey. Services, labs, and medications covered may vary.

What if my provider determines I am no longer eligible for the Subscription Services?
If your provider determines you are no longer eligible, your subscription will be canceled and a refund may be issued. If you have questions about an eligibility-initiated cancellation, please contact our customer service at [rx@intimaterose.com].

Unless otherwise stated herein, Terms and Conditions govern this Subscription Services Cancellation and Refund Policy, in all events, you are responsible for all fees from services and healthcare services rendered. This policy governs fees for Subscription Services only.