Medical Consent
Informed consent for telehealth services and compounded medication through the ProviaRx platform
Last Updated: April 12, 2026 · Effective Immediately
Please read this document carefully. By submitting a health assessment through the ProviaRx platform, you acknowledge that you have read, understood, and agree to the terms described in this Medical Consent. This consent is collected electronically during your assessment (Step 6) and constitutes a legally binding agreement.
1. Platform Disclosure — What ProviaRx Is and Is Not
ProviaRx, LLC (DBA of Saha Services LLC) is a technology and administrative services platform only. ProviaRx:
- Does NOT employ physicians or other licensed healthcare providers
- Does NOT practice medicine or provide medical advice
- Does NOT make prescribing decisions
- Does NOT dispense or ship medications
- Does NOT guarantee that you will be approved for any treatment
All prescribing decisions are made exclusively by independent licensed healthcare providers who are not employees of ProviaRx. All medications are dispensed by independent state-licensed compounding pharmacies that are not affiliated with ProviaRx.
⚠️ This is not a patient-physician relationship with ProviaRx. Your healthcare relationship is with the independent licensed physician who reviews your assessment, not with ProviaRx, LLC.
2. Consent to Telehealth Services
You consent to the use of telehealth (asynchronous store-and-forward technology) for the delivery of healthcare services through the ProviaRx platform. You understand and agree that:
Nature of Telehealth
- Your health assessment is reviewed asynchronously — you and the physician are not interacting in real time
- The physician reviews your submitted health information without a face-to-face or live video consultation (except in states where required by law)
- Telehealth has limitations and may not be appropriate for all medical conditions
- In the event of an emergency, you should call 911 or go to the nearest emergency room immediately
State-Specific Requirements
Some states require a live video consultation (synchronous telehealth) before a physician may prescribe medication. If your state requires this, you will be notified during the assessment process and the independent physician will arrange a video consultation before prescribing.
Technical Failures
In the event of technical failures that prevent completion of your assessment or communication with your physician, contact care@proviarx.com or seek care from a local healthcare provider.
3. Informed Consent for Compounded Medications
⚠️ IMPORTANT — Please Read Carefully: The medications that may be prescribed through this platform are compounded medications. Compounded medications are NOT FDA-approved. This means they have not been evaluated by the U.S. Food and Drug Administration for safety, efficacy, or quality in the same manner as commercially manufactured drugs.
What Are Compounded Medications?
Compounded medications are custom-prepared by licensed compounding pharmacies to meet the specific needs of individual patients when commercially available medications do not meet their needs. Compounding pharmacies are regulated by state pharmacy boards and, in some cases, the FDA.
Compounded GLP-1 Medications (Semaglutide/Tirzepatide)
You understand and acknowledge that:
- Compounded semaglutide and tirzepatide contain the same active ingredients as Ozempic®, Wegovy®, Mounjaro®, and Zepbound® — but are NOT those brand-name products and are NOT FDA-approved
- Compounded medications may differ from FDA-approved versions in inactive ingredients, formulation, and quality standards
- The long-term safety and efficacy of compounded GLP-1 medications have not been independently studied to the same extent as FDA-approved versions
- Common side effects include nausea, vomiting, diarrhea, constipation, and injection site reactions
- Serious but rare risks include pancreatitis, gallbladder disease, kidney problems, and in animal studies (not confirmed in humans) thyroid C-cell tumors
- GLP-1 medications are contraindicated in patients with personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN2)
Compounded Testosterone Cypionate
You understand and acknowledge that:
- Testosterone is a Schedule III controlled substance under federal law — obtaining it without a valid prescription is a federal crime
- Compounded testosterone cypionate is not FDA-approved as a compounded product
- Risks include polycythemia (increased red blood cell count), cardiovascular effects, suppression of natural testosterone production, infertility, acne, and mood changes
- Regular monitoring (blood tests) is required for safe testosterone therapy
- Testosterone therapy is not appropriate for everyone and the prescribing physician will make an independent determination of your eligibility
4. Accuracy of Health Information
⚠️ Federal Law Notice: Providing false or fraudulent information to obtain prescription medications, including controlled substances, is a federal offense under 21 U.S.C. § 843 and may result in criminal prosecution, fines, and imprisonment.
You certify that all information provided in your health assessment is true, accurate, and complete to the best of your knowledge. You understand that:
- The independent physician relies on your self-reported information to make prescribing decisions
- Inaccurate information could result in inappropriate prescribing and potential harm to your health
- Your identity may be verified before prescription fulfillment
- Date of birth and name must match your government-issued ID
- Intentionally providing false medical information to obtain controlled substances is a federal crime
5. No Guarantee of Approval or Results
You understand and acknowledge that:
- Submission of a health assessment does not guarantee that a prescription will be issued
- The independent licensed physician may decline to prescribe for any clinically appropriate reason
- Individual results from GLP-1 or hormone therapy vary and are not guaranteed
- ProviaRx makes no representations about the likelihood of approval or expected treatment outcomes
- If your physician declines and no medication has shipped, you will receive a full refund of any subscription fees paid
6. Release of Health Information
You authorize ProviaRx to transmit your Protected Health Information (PHI) to:
- Independent licensed physicians in ProviaRx's network, for the purpose of reviewing your health assessment and making prescribing decisions
- Independent licensed compounding pharmacies, for the purpose of dispensing and shipping medication if a prescription is issued
- Technology service providers operating under HIPAA Business Associate Agreements, as necessary to operate the platform
This authorization is valid for the duration of your subscription and any legally required record retention period. You may revoke this authorization at any time by contacting legal@proviarx.com, with the understanding that revocation will prevent us from providing services to you.
7. Your Responsibilities as a Patient
By using the ProviaRx platform, you agree to:
- Provide complete, accurate, and truthful information in your health assessment
- Immediately inform your prescribing physician of any changes in your health status, new medications, or adverse reactions
- Follow the instructions provided by the independent physician regarding your medication
- Not share your prescription medication with others
- Not use the platform for emergency medical situations — call 911 for emergencies
- Maintain current contact information to receive important notifications about your care
- Notify us of any adverse reactions by emailing care@proviarx.com
💊 Medication Storage: Store all medications as directed on the label. Keep out of reach of children. Testosterone is a controlled substance — store securely and dispose of properly. Do not share medications with others.
8. Summary of Consent Items
The following items are acknowledged during Step 6 of your health assessment. This section provides the full context for each consent item.
Your Consent Acknowledgments
1
Accuracy of Information: All information I provided is truthful, complete, and accurate. I understand false medical information is dangerous and may result in inappropriate prescribing. Providing false information to obtain controlled substances is a federal offense under 21 U.S.C. § 843.
2
Platform Disclosure: I understand ProviaRx is a technology platform ONLY — it does not employ physicians, practice medicine, or dispense medications. All clinical decisions are made exclusively by independent licensed physicians.
3
Physician Review Consent: I consent to an independent licensed physician reviewing my health information to determine if treatment is appropriate. I understand they may decline my request without a refund of assessment costs (subscription refund is provided if declined).
4
Compounded Medication Notice: I understand that the medications potentially prescribed through this platform are compounded medications that are NOT FDA-approved. I acknowledge the risks described in this Medical Consent and the FDA's position on compounded medications.
5
No Guarantee of Results: I understand that individual results vary. ProviaRx and the independent physicians make no guarantee of treatment outcomes, weight loss, hormone improvements, or any specific health result.
6
Terms and Privacy: I have read and agree to ProviaRx's Terms & Conditions, Privacy Policy, and HIPAA Notice of Privacy Practices, and consent to the use of my health information as described in those documents.