beBIONIC Telehealth Consent Form
Last revised: July 23, 2025
Welcome to beBIONIC, LLC, Tampa’s premier medical spa dedicated to empowering your health journey through personalized clinical and aesthetic treatments. This Telehealth Consent Form (“Consent Form”) governs your use of telehealth services provided by beBIONIC, LLC (“beBIONIC,” “we,” “us,” or “our”) through the www.bebionicnow.com website (the “Site”) or other secure telecommunication platforms. By signing or electronically agreeing to this Consent Form, you (“you” or “your”) acknowledge that you have read, understand, and agree to the terms outlined below, as well as our Terms and Conditions, available here, and our Privacy Policy, available here, which comply with U.S. HIPAA regulations.
1. Overview of Telehealth Services
beBIONIC offers telehealth consultations as a convenient option to access our clinical and aesthetic treatments, including hormone therapy, weight management, and skin rejuvenation. Telehealth services involve the use of secure synchronous (e.g., video calls) and asynchronous (e.g., messaging) telecommunications technologies to connect you with our licensed professionals (e.g., Doctors [MD/DO], Nurse Practitioners, Physician Assistants) for consultations, assessments, and treatment planning. These services are provided in compliance with Florida telehealth laws (Florida Statutes §456.47) and are intended to complement, not replace, in-person care with your primary healthcare provider.
Not for Emergencies: Telehealth services are not suitable for medical emergencies. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, DIAL “911” IMMEDIATELY. Do not use telehealth services to address urgent conditions or delay seeking emergency care.
2. Nature of Telehealth Consultations
Telehealth consultations allow you to discuss your health concerns, receive medical advice, and develop treatment plans remotely. A provider-patient relationship is established only after a formal telehealth consultation with one of our licensed professionals. During telehealth consultations:
- You will interact with a licensed professional via secure video, phone, or messaging platforms.
- The professional may assess your medical history, symptoms, and needs to recommend treatments, which may include prescriptions for brand-name or compounded medications.
- Follow-up care, including in-person visits, may be recommended to ensure comprehensive treatment.
3. Benefits of Telehealth Services
Telehealth consultations offer several benefits, including:
- Convenience: Access personalized care from the comfort of your home or preferred location.
- Accessibility: Receive expert advice without the need for travel to our Tampa, FL, facility.
- Flexibility: Schedule consultations at times that suit your lifestyle.
- Personalized Care: Work with our licensed professionals to develop treatment plans tailored to your health goals.
4. Risks of Telehealth Services
While telehealth services are designed to provide safe and effective care, you acknowledge the following potential risks:
- Limited Information Transmission: Information provided during telehealth consultations (e.g., images, medical history) may be insufficient for accurate medical decision-making due to factors like poor resolution or incomplete data.
- Technical Issues: Delays in evaluation or treatment may occur due to failures in electronic equipment or connectivity issues.
- Incomplete Medical Records: Lack of access to your full medical records may lead to adverse drug interactions, allergic reactions, or other clinical errors.
- Privacy Risks: Despite our use of HIPAA-compliant security protocols, there is a risk of unauthorized access to or breaches of your personal health information.
- Limited Physical Examination: Telehealth consultations may not include a physical exam, which could affect the accuracy of diagnoses or treatment recommendations.
You agree to provide accurate and complete medical history, contact information, and other relevant details to minimize these risks and ensure safe care.
5. Medications and Prescriptions
Based on the professional judgment of our licensed professionals, telehealth consultations may result in prescriptions for brand-name or compounded medications to support your treatment plan. Prescriptions are provided solely for your personal use, and you agree to:
- Fully read and follow all provided product information and labels.
- Contact a healthcare provider or pharmacist with any questions about your prescription.
- Notify your beBIONIC provider of any adverse reactions or concerns.
Prescriptions are fulfilled by LegitScript-certified or NABP-accredited pharmacies, and you have the freedom to choose your preferred pharmacy for fulfillment. beBIONIC does not prescribe DEA-controlled substances (e.g., opioids, amphetamines).
6. Patient Responsibilities
To ensure safe and effective telehealth services, you agree to:
- Provide accurate and complete medical history, including current medications, allergies, and health conditions.
- Use secure, private devices and internet connections for telehealth consultations to protect your personal health information.
- Follow all treatment recommendations, including scheduling in-person follow-ups when advised by your provider.
- Notify beBIONIC immediately of any technical issues, adverse reactions, or concerns during or after a telehealth consultation.
- Refrain from using telehealth services for emergencies or urgent conditions.
7. Privacy and Security
beBIONIC uses HIPAA-compliant platforms to protect your personal health information during telehealth consultations. However, no system is entirely risk-free, and you acknowledge the potential for privacy breaches. Our Privacy Policy, available here, outlines how we collect, use, and protect your information. You agree to take reasonable steps (e.g., using secure devices, avoiding public Wi-Fi) to safeguard your data during telehealth interactions.
8. Regulatory Compliance
beBIONIC’s telehealth services comply with all applicable state and federal regulations, including:
- Licensure: All telehealth consultations are conducted by licensed professionals with active credentials, including DEA Certificates for prescribing controlled substances (e.g., testosterone, Low Dose Naltrexone).
- Florida Telehealth Laws: Services adhere to Florida Statutes §456.47, including requirements for licensure, patient verification, and secure communication platforms.
- HIPAA Compliance: Your personal health information is protected in accordance with U.S. HIPAA regulations.
- Non-Discrimination: beBIONIC provides telehealth services without discrimination based on race, color, national origin, age, disability, or sex.
You agree to provide accurate information to support compliance with these regulations, including Whois information for domain transparency.
9. Consent to Telehealth Services
By signing or electronically agreeing to this Consent Form, you confirm that you:
- Understand the nature, benefits, and risks of telehealth services as described above.
- Agree to receive telehealth consultations from beBIONIC’s licensed professionals.
- Consent to the use of secure telecommunication technologies for consultations, assessments, and treatment planning.
- Acknowledge that telehealth services are not suitable for emergencies and may require in-person follow-up care.
- Agree to comply with beBIONIC’s Terms and Conditions, Privacy Policy, and any additional instructions provided by your healthcare provider.
10. Withdrawal of Consent
You may withdraw your consent to telehealth services at any time by contacting beBIONIC at [Insert Email Address]. Withdrawal of consent will not affect your ability to receive in-person services at our Tampa, FL, facility, but it may limit access to telehealth-specific features.
11. Contact Us
If you have questions about this Consent Form or our telehealth services, please contact:
beBIONIC, LLC
16011 N Nebraska Ave Suite 105, Lutz, FL 33549
By signing or electronically agreeing to this Consent Form, you acknowledge that you have read, understand, and agree to its terms and are ready to embark on your health journey with beBIONIC’s telehealth services.
