Telehealth Consent
Effective September 28, 2026
BioForm Rx is a DBA (assumed name) of The Tide Clinic PLLC, a Texas professional limited liability company. Our mailing address is 6909 Grand Blvd, Houston, TX 77054. Questions about this document can be sent to support@bioformrx.com.
This consent explains how telehealth works at BioForm Rx, its benefits and risks, and your rights. You will be asked to accept it during intake. Please read it carefully and contact us at support@bioformrx.com with any questions before you agree.
What telehealth is
Telehealth is the delivery of healthcare services using electronic communications when you and your provider are in different locations. At BioForm Rx this includes secure online intake questionnaires, messaging through the patient portal, review of your medical history and lab results (sometimes called asynchronous or store-and-forward care), and live video visits.
Who will treat you
Your care is provided by physicians, nurse practitioners and physician assistants employed or contracted by The Tide Clinic PLLC and licensed in the state where you are located during your visit. Your provider’s name and credentials are shown to you before and during your care and are listed on our Providers page. You may ask about your provider’s licensure at any time.
How your care will work
- You complete an intake questionnaire, verify your identity with a government-issued photo ID, and complete any required lab work.
- A provider reviews your information and lab results. For some treatments the provider may issue a treatment decision after this review and any follow-up questions; for others, including all controlled substances such as testosterone, a live audio-video visit with the provider is required before any prescription is issued.
- If treatment is appropriate, the provider issues a prescription to the pharmacy you selected. If it is not, the provider will explain why and, when appropriate, recommend other options or in-person care.
- Ongoing care includes scheduled check-ins, repeat lab work and dose adjustments as your provider directs. You must complete required monitoring to continue treatment.
Benefits
Telehealth gives you access to licensed providers without travel, allows care to be delivered more efficiently, and lets you communicate with your care team through a secure portal.
Risks and limitations
- A provider cannot perform a hands-on physical examination through telehealth. Some conditions require in-person evaluation, and your provider may decline to treat you or refer you for in-person care.
- Information you provide, including photos, may not be sufficient for a provider to make a decision, which may delay care or require additional steps.
- Technology can fail. Video or connectivity problems may interrupt a visit; if so, we will reschedule or contact you by another method.
- Although we use secure, encrypted systems, electronic communications carry some risk of unauthorized access.
- Telehealth care is not appropriate for emergencies. If you have chest pain, difficulty breathing, thoughts of harming yourself or others, or any other emergency, call 911 or go to the nearest emergency room.
Medications
- You will receive a prescription only if a licensed provider determines it is medically appropriate. No medication is guaranteed.
- Controlled substances, including testosterone, are prescribed only after a live audio-video visit and in accordance with federal and state law. Additional requirements, including an in-person evaluation, may apply if the law changes.
- Compounded medications are prepared for you individually by a licensed pharmacy when your provider determines a compounded formulation is appropriate. They are not FDA-approved. Your provider will discuss the reasons for prescribing a compounded medication and its risks and benefits.
- You agree to take medication only as prescribed, to report side effects promptly, and not to share medication with anyone else.
Your rights
- You may withdraw this consent and stop telehealth care at any time, without affecting your right to future care. Withdrawal may be done in writing through the patient portal or by email. Discuss stopping any medication with your provider first.
- You may request in-person care or a referral at any time.
- You may request a copy of your medical records as described in our Notice of Privacy Practices.
- You may choose any licensed pharmacy to fill your prescription, as described in our Pharmacy Choice Disclosure.
- Your information is protected under HIPAA and applicable state law. Video visits are not recorded unless you agree in advance.
Your responsibilities
- Provide accurate and complete information about your identity, location, health history and medications.
- Confirm the state you are physically in at the time of each visit. We can only treat you when you are in a state where your provider is licensed.
- Keep your contact information current and respond to messages from your care team.
- Use a private location and secure internet connection for video visits.
Complaints
If you have a concern about your care, contact us at support@bioformrx.com. You may also contact the Texas Medical Board at 1-800-201-9353 or www.tmb.state.tx.us, or the medical licensing board in your state.
Consent
By checking the consent box during intake, you confirm that you have read and understand this document, that you have had the opportunity to ask questions, that you are at least 18 years old, and that you consent to receive healthcare services from BioForm Rx through telehealth.