Telehealth Consent (Menopause & Weight Loss)

Privacy and SecurityText and Email CommunicationImportant 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 & Security

Your personal health information is protected under applicable privacy laws, including HIPAA. By using our telehealth services, you authorize the sharing of your health information with your provider and, when appropriate, with pharmacies or labs involved in your care.

While we use industry-standard security measures, you acknowledge that telehealth carries inherent risks such as technical failures or unauthorized access. Intimate Rose is not responsible for disruptions, data loss, or security breaches caused by technology outside our control.

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.

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.

Text and Email Communication

By submitting the form you give permission for Intimate Rose to contact you via SMS/text or email about:

  • Appointment reminders
  • General health information

You can request to stop them at any time.

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:

Cancellations

  1. You may cancel your subscription at any time.
  2. Cancellations stop future charges, but payments already processed cannot be refunded.
  3. To avoid the next billing, cancellations must be received at least 72 hours before your renewal date.

Refunds

Refunds are only offered in limited cases:

  1. Medical Disqualification – If our licensed provider determines you are not medically eligible for treatment.
  2. Billing Error – If a duplicate or incorrect charge occurs.
  3. Pharmacy/Shipping Delay – If your medication hasn’t shipped within 21 days of provider approval.
  4. Damaged Medication – If medication arrives damaged or overheated as defined by our medical team, we’ll send a replacement at no cost (refunds are not available in this case).

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.

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.

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