Waiver & Consent
Waiver & Consent Agreement
Last updated: May 1, 2025
This Waiver & Consent Agreement (“Agreement”) outlines the terms of telemedicine services provided through this website (“Platform”) by licensed medical professionals. By using this service, you agree to the following terms in full.
Telehealth Consent
I understand that:
- I am voluntarily engaging in a telemedicine consultation, which involves the remote evaluation and management of my medical condition.
- The healthcare provider will determine whether a prescription is clinically appropriate based on their professional judgment.
- Telehealth may involve electronic communication of personal medical information, including medical history, documents, ID verification, and prescriptions.
- I have the right to withdraw consent for telehealth at any time by discontinuing use of this service.
- Medical Disclosure & Evaluation
I acknowledge that:
- I will truthfully provide my medical history, current prescriptions, diagnoses, and upload a valid, government-issued ID.
- I understand that completing the intake form and/or consult does not guarantee a prescription.
- A valid prescription will only be issued if the provider determines it is safe and medically appropriate.
- I may be denied medication if I withhold information, present risks of abuse/diversion, or if clinical red flags are identified.
- Controlled Substance Policy
I acknowledge that:
- Medications offered through this platform (such as Adderall, Xanax, and Ambien) are federally controlled substances.
- I am prohibited from misusing, selling, or sharing prescribed medications.
- I understand that forging records or providing false information may result in termination of services and reporting to authorities.
- Medication refills are subject to ongoing clinical review and monthly administration fees.
- Prescription Shipping & Fulfillment
- If prescribed, medications will be sent to a pharmacy and shipped via overnight delivery to the address that matches the ID I submit.
- The platform does not guarantee shipping timelines and is not responsible for delays once prescriptions are sent to the pharmacy.
- I understand that I must notify the provider of any address change immediately.
- Non-Refundable Services
- Due to the nature of medical evaluations, all consultation fees are final and non-refundable, regardless of prescription outcome.
- This policy applies to all evaluations, follow-ups, and administration fees.
- By submitting payment, I acknowledge that I am purchasing a medical evaluation, not a guaranteed prescription.
- Monthly Administration Fee
- A monthly administrative fee of $24.99 will be charged for ongoing medication support, prescription processing, refill management, and customer care.
- Failure to maintain this subscription may result in lapse of prescription support.
- Privacy & HIPAA Compliance
- I understand that my information is protected under HIPAA and will be kept confidential unless required by law.
- I consent to the electronic storage and transmission of my health information.
- Limitation of Liability
- I understand that this platform, its providers, and partners are not liable for outcomes related to treatment decisions made based on information I provided.
- I release the platform and its affiliated medical professionals from all claims arising from my use of this service, including but not limited to: treatment decisions, denial of service, delayed shipping, or misuse of prescribed medications.
- Patient Acknowledgment
By checking the box below and continuing with this service:
- I confirm I have read, understood, and agree to all terms listed in this Waiver & Consent.
- I certify that all information I provide is true and complete to the best of my knowledge.
- I consent to receive medical care through telemedicine.
☑ I have read and agree to the above Waiver & Consent.
Discreet, fully remote evaluations for ADHD, anxiety, PTSD, depression, and sleep disorders—no in-person visits, no long delays.
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Contact Us
- New York, New York USA
- info@adderallrx.com
Legal/Disclaimer
All medications are prescribed only if medically appropriate. Completion of assessment does not guarantee a prescription. All services are final – no refunds will be issued due to the nature of medical evaluations.