Legal

Medical Consent

Effective Date: July 1, 2026
Last Updated: July 1, 2026

This document contains the consents and authorizations you agree to when you use the SurpassMD platform operated by Life Vitality LLC (“SurpassMD,” “we,” “us,” or “our”). By checking the box or clicking to accept, and by using the Services, you (the patient, “I” or “you”) agree to each of the consents below. Please read them carefully. Capitalized terms have the meanings given in our Terms of Use.

Emergencies. Telehealth is not for emergencies. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room.

You agree to each consent separately. At intake you will be asked to agree to the consents below, and agreeing to them is required to receive treatment. Any consent to receive marketing communications is optional, is presented to you separately, and is not required to use the Services or to receive care.

1. Consent to Telehealth

I consent to receive healthcare services through telehealth, which is the delivery of healthcare using electronic communications, information technology, or other means between a provider and a patient who are not in the same physical location. I understand that an independent, licensed Provider, and not SurpassMD, will evaluate the information I submit and decide whether treatment is appropriate.

I understand the potential benefits of telehealth, including improved access to care and convenience, and the potential risks, including that information transmitted may not be sufficient for the Provider to make a clinical decision, that technical failures or delays may occur, that security protocols could fail, and that, in rare cases, a lack of in-person examination could affect the Provider’s assessment. I understand that the Provider may determine that telehealth is not appropriate for me and that I should seek in-person care.

I understand that, before treatment, I will be required to review and accept the Provider’s own consent to telehealth, available here, and that the Provider’s consent governs the clinical care relationship. I may withdraw my consent to telehealth at any time, except to the extent care has already been provided.

2. Acknowledgment of Notice of Privacy Practices (HIPAA)

I acknowledge that the Providers and Pharmacies that treat me are covered by HIPAA and that they maintain a Notice of Privacy Practices describing how my protected health information may be used and disclosed and my rights regarding that information. I acknowledge that the Notice of Privacy Practices is available to me here, and that I have had the opportunity to review it. I understand that SurpassMD is not a HIPAA covered entity and that information I provide to SurpassMD as a platform is handled under the SurpassMD Privacy Policy.

3. Financial Agreement and Authorization to Charge

I understand that the Services are paid for out of pocket and are not billed to insurance, Medicare, or Medicaid, and that I will not seek reimbursement from Medicare or Medicaid. I authorize SurpassMD and the third-party payment processor that collects payments for the program to charge the payment method I provide for all amounts due, including any one-time fees and recurring subscription charges, which may appear on my statement under a descriptor such as “OPNLP.”

Automatic renewal. I understand and agree that any subscription I purchase automatically renews and that my payment method will be charged on a recurring basis at the then-current price until I cancel, as described in the Terms of Use. I understand that I may cancel at any time to stop future charges, and that I may request a refund at any time, which will be provided except for a billing period whose medication has already been ordered or shipped to me.

4. Consent to the Use of Compounded Medications

I understand that a product prescribed to me may be a compounded medication, that compounded medications are not approved by the U.S. Food and Drug Administration (FDA), and that the FDA does not review compounded medications for safety, effectiveness, or quality before they are marketed. I understand that a compounded medication may differ in appearance, packaging, or other characteristics from any FDA-approved product, and that I have reviewed the Important Safety Information made available to me. I understand that the specific pharmacy, formulation, concentration, inactive ingredients, storage requirements, dosing device, and the patient-specific reason for compounding are determined by my Provider and the Pharmacy and are disclosed to me in the information provided with my medication, which I agree to review. For injectable medications such as GLP-1 medications, I understand that concentrations may vary, that a dose may be expressed in milligrams or in units, and that measuring or self-administering the wrong amount, making titration errors, or failing to store the medication at the correct temperature can be dangerous; I will follow the instructions provided and ask my Provider if I am unsure. I consent to treatment with a compounded medication if my Provider determines it is appropriate.

5. Consent to Controlled-Substance Treatment

I understand that some treatments offered through the Services, including testosterone, are controlled substances regulated under federal and state law, including the Controlled Substances Act, the Ryan Haight Act, DEA rules, and my state’s controlled-substance and telehealth laws. I understand that the availability of controlled-substance treatment depends on my state and my physical location, that it may not be available in all states or to all patients, and that my Provider will prescribe only where permitted by law. I understand and agree that my Provider may require laboratory tests, identity verification, ongoing monitoring, or an in-person examination before or during treatment, depending on my state and applicable law; that a controlled-substance prescription is not guaranteed and that early or replacement refills may be limited; and that my information may be reported to a state prescription drug monitoring program (PDMP) as required by law. I confirm that I am physically located in the state I have identified to SurpassMD, and I agree to complete any additional steps my state requires. I agree to use any controlled substance only as prescribed and only for myself, and not to misuse, divert, share, sell, or transfer it. I understand that testosterone therapy may reduce my fertility and carries the risks described in the Important Safety Information, and that if I am prescribed a topical testosterone product, I must take precautions to avoid transferring it to others, especially women and children, through skin contact.

6. Shipping Authorization

I authorize the Pharmacy to ship any prescribed medication to the address I provide. I agree to provide an accurate shipping address and to store and handle temperature-sensitive medications according to the instructions provided. If a shipment is lost, delayed, damaged, or may have been exposed to improper temperatures, I will not use the medication and will contact SurpassMD so the Pharmacy can determine whether it is safe to use or must be replaced.

7. Consent to Electronic Communications

I consent to receive communications, disclosures, agreements, and notices electronically, including by email, text message, and through the Services, and I agree that electronic communications satisfy any requirement that a communication be in writing. I understand that message and data rates may apply to text messages, that I may reply STOP to opt out of marketing texts, and that opting out may affect certain treatment notifications.

8. Voluntary Consent

I confirm that I am at least 18 years old, that the information I have provided is true and complete, that I have had the opportunity to ask questions, and that I am giving these consents voluntarily. I understand that I may decline or withdraw any consent, but that doing so may mean I cannot use the Services.

9. Questions

If you have questions about these consents, or need to reach us about a shipment, a safety concern, cancellation, or a refund, contact us at support@surpassmd.com, or by mail at Life Vitality LLC dba SurpassMD, 16192 Coastal Highway, Lewes, DE 19958.