Informed Consent
This Informed Consent document explains your rights, the nature of the services provided, and the risks associated with compounded GLP-1 medications. By proceeding with a NuviaRX consultation, you acknowledge that you have read, understood, and agree to the terms described here.
Nature of Telehealth Services
I understand that NuviaRX is a telehealth technology platform that connects me with independent licensed healthcare providers. I understand that my consultation will take place remotely and that my provider cannot perform physical examinations. I understand that clinical determinations will be based solely on information I provide through the intake questionnaire and any supporting documentation I submit.
Compounded Medications
I understand and acknowledge that:
- The medications that may be prescribed through NuviaRX are compounded by licensed 503A pharmacies
- Compounded medications are not FDA-approved
- The FDA has removed semaglutide and tirzepatide from its drug shortage list
- Compounded medications have not been evaluated by the FDA for safety, efficacy, or quality
- A valid prescription from a licensed physician is required before any medication is dispensed
Risks & Side Effects
I understand that GLP-1 receptor agonists, including semaglutide and tirzepatide, may cause side effects including but not limited to:
- Nausea, vomiting, diarrhea, and constipation
- Decreased appetite and changes in food tolerance
- Fatigue during dose escalation
- In rare cases, pancreatitis, gallbladder issues, or thyroid changes
I understand that these medications carry a warning regarding potential risk of thyroid C-cell tumors based on animal studies, though this has not been confirmed in humans. I agree to inform my provider of any personal or family history of thyroid cancer or MEN2 syndrome.
If I experience a medical emergency or severe adverse reaction, I will call 911 immediately. For non-emergency adverse events, I will contact my provider and report to FDA MedWatch at 1-800-FDA-1088.
No Guarantee of Prescription or Outcome
I understand that completing a consultation does not guarantee that a prescription will be issued. My provider will determine eligibility based on my individual health profile. I understand that individual weight loss results vary and that NuviaRX makes no guarantee of any specific outcome.
Accurate Information
I agree to provide complete and accurate health information in my intake questionnaire and all communications with my provider. I understand that providing inaccurate or incomplete information may affect the safety and appropriateness of any medication prescribed.
HIPAA Authorization
I authorize NuviaRX and my assigned independent provider to use and share my protected health information as necessary to facilitate my care, including sharing with the compounding pharmacy fulfilling my prescription. I understand that my health information is protected under HIPAA and will not be sold to third parties.
Right to Withdraw
I understand that I may withdraw consent and cancel my program at any time without penalty. I may do so by contacting NuviaRX support before my next billing date.
Acknowledgment
By proceeding with my NuviaRX consultation and/or program enrollment, I confirm that I have read this Informed Consent document, that I understand its contents, and that I voluntarily agree to its terms.