Consents

MyBodyMyRx

Patient Telemedicine & Medication Informed Consent

By using this website and requesting medical care through MyBodyMyRx, you acknowledge that you have read, understood, and agree to the following telemedicine and medication consent terms. If you do not agree, you must not use this service.

1. Telemedicine Consent

What is telemedicine and how is care provided here?

Telemedicine involves the delivery of healthcare services using secure electronic communications, including online forms, asynchronous messaging, and, when applicable, audio or video technologies. A licensed clinician reviews the information you submit, may ask follow-up questions, and may provide diagnoses, treatment recommendations, and prescriptions when medically appropriate.

What are the limitations of telemedicine?

  • There is no in-person physical examination.
  • Some conditions cannot be safely diagnosed or treated remotely.
  • Your clinician relies on the accuracy and completeness of the information you provide.
  • Technical failures, delays, or interruptions may occur.
  • Although safeguards are used, there is a small risk of unauthorized access to electronic data.

Alternative: You always have the option to seek care in person from a local clinic, primary care clinician, OB/Gyn, urgent care, or other healthcare provider instead of or in addition to using this telemedicine service.

What do I verify by using this service?

  • You are physically located in the state you select at the time of your visit.
  • You are at least 18 years old or otherwise legally able to consent for care in your state.
  • All information you provide (medical history, medications, allergies, pregnancy status, and pharmacy) is complete, accurate, and truthful to the best of your knowledge.
  • You will promptly update your information if anything changes.

Is telemedicine for emergencies?

No. Telemedicine through MyBodyMyRx is not for emergencies or urgent, life-threatening issues. If you experience chest pain, trouble breathing, severe headache, confusion, sudden weakness, heavy bleeding, severe abdominal pain, fainting, suicidal thoughts, or any other emergency symptom, you must call 911 or go to the nearest emergency department immediately.

What am I consenting to by continuing?

  • Evaluation and treatment using secure electronic communication.
  • Electronic prescribing to a pharmacy of your choice when medically appropriate.
  • Creation, storage, and use of electronic medical records related to your care.
  • Communication of your health information as allowed by law for treatment, payment, and healthcare operations.

Can my clinician decline or stop telemedicine care?

Yes. A clinician may decline to provide care, limit prescriptions, or recommend in-person evaluation at any time if telemedicine is not safe or appropriate, if your information is incomplete or concerning, or if you do not follow recommended testing or follow-up.

Telemedicine Acknowledgement

I understand that MyBodyMyRx provides reproductive healthcare services and does not diagnose, treat, or manage chronic medical conditions.

If I am under the care of other healthcare professionals or currently taking prescription medications, I understand that I should discuss any changes with the prescribing provider and should not stop or alter any medication without first consulting them.

I acknowledge that I have chosen to receive care through MyBodyMyRx and understand that the information and services provided are not intended to replace care from other healthcare professionals.

I acknowledge that I am responsible for my own health and well-being and for providing complete, accurate, and truthful information throughout the intake and care process.

I understand that MyBodyMyRx will keep my personal and protected health information private and confidential and will not share my information with third parties unless required by law.

I acknowledge that my participation in services provided by MyBodyMyRx is voluntary. I hereby waive, release, and discharge MyBodyMyRx and its employees from liability for injury, loss, or damages that may arise from my participation, except in cases of gross negligence by MyBodyMyRx.

I acknowledge and accept the risks and limitations of telemedicine services, including the possibility of incomplete information or delayed diagnosis. I agree to participate voluntarily and understand that MyBodyMyRx and its clinicians are not responsible for outcomes that result from inaccurate or incomplete information I provide, except as required by law.

All telehealth services provided through MyBodyMyRx are rendered by APRNs licensed and certified in the state of which the patient is physically present. APRNs are licensed and in good standing with the state boards of nursing and regulations.

I understand that I may seek in-person care instead of telemedicine and that I am not required to use this service.

2. Scope of Care & Service Limitations

What is the focus of this service?

MyBodyMyRx provides limited-scope telemedicine care for period delay, contraception and emergency contraception for females sex at birth between the ages of 18-54. including counseling, prescribing when safe, and short educational guidance. This service does not replace a primary care clinician, OB/Gyn, or in-person examination.

What is not provided?

  • No routine physical exams, Pap smears, pelvic exams, or STI testing.
  • No prenatal care, fertility evaluation, or management of pregnancy complications.
  • No chronic disease management (for example: uncontrolled hypertension, diabetes, complex autoimmune disease).
  • No controlled substance prescribing.
  • No disability, work-excuse, FMLA, or legal paperwork.
  • No crisis or emergency mental health care.
Information on this site is for general education only and does not replace in-person evaluation, testing, or individualized medical advice from your own clinicians.

3. Birth Control Informed Consent

What should I know about hormonal birth control?

  • Hormonal birth control does not protect against sexually transmitted infections (STIs).
  • No method of contraception is 100% effective; pregnancy can still occur.
  • Common side effects may include nausea, breast tenderness, mood changes, acne changes, headaches, and spotting or irregular bleeding.
  • Effectiveness depends heavily on taking or using the method exactly as prescribed.

What are the risks of estrogen-containing birth control?

  • A small but real increased risk of blood clots, stroke, and heart attack.
  • Higher risk if you smoke, especially if you are age 35 or older.
  • Higher risk with migraine with aura, history of blood clots, certain heart or vascular conditions, or uncontrolled high blood pressure.
  • Estrogen may be unsafe in certain liver disease, some cancers, and certain autoimmune or clotting disorders.

When should I seek emergency care while on birth control?

  • Sudden severe chest pain or shortness of breath.
  • Severe headache, confusion, or difficulty speaking.
  • Sudden vision loss or vision changes.
  • New, severe leg pain or swelling, especially in one calf.
  • Severe abdominal pain or heavy, uncontrolled bleeding.

What about progestin-only birth control?

  • Requires strict daily timing for pills to be most effective.
  • Irregular bleeding or spotting is more common.
  • May be preferred or required when estrogen is not safe (for example, migraines with aura, certain clotting risks, or postpartum situations).

What do I confirm before receiving birth control?

  • To the best of your knowledge, you are not currently pregnant.
  • You will use backup contraception as directed when starting, switching, or if you miss doses.
  • You will check your blood pressure as recommended and inform your clinicians if it is high.
  • You will report new migraines, smoking, surgery, hospitalizations, blood clots, or major medical changes before continuing estrogen-containing methods.
  • You understand that your clinician may change, limit, or decline a prescription if there are safety concerns.

4. Emergency Contraception (EC) Informed Consent

What does emergency contraception do?

  • Lowers the chance of pregnancy after unprotected intercourse or birth control failure.
  • Is not 100% effective and is less effective the longer you wait to take it.
  • Does not end an existing pregnancy and is not an abortion pill.
  • Does not provide protection for future unprotected sex.

What affects how well EC works?

  • The time between unprotected sex and taking the medication (sooner is better).
  • Where you are in your menstrual cycle (closer to ovulation = less effective).
  • Body weight and BMI for some EC options.
  • The specific EC medication prescribed and whether directions are followed exactly.

What side effects can occur with EC?

  • Nausea, vomiting, headache, dizziness, or fatigue.
  • Breast tenderness or cramping.
  • Irregular bleeding or spotting.
  • A period that is earlier, later, heavier, or lighter than usual.

When should I seek follow-up care after EC?

  • If you vomit within 3 hours of taking the medication (you may need another dose or in-person care).
  • If your next period is more than about 1 week late.
  • If you have severe abdominal pain or heavy bleeding.
  • If you have a positive pregnancy test.

4B. Period Delay (Norethindrone) Informed Consent

What is norethindrone used for in this service?

Norethindrone is a progestin (a hormone similar to progesterone) that may be prescribed short-term to help delay menstrual bleeding for a planned event, travel, or special occasion.

How does period delay medication work?

  • When started before bleeding begins, norethindrone may temporarily delay your period.
  • Your period usually returns within a few days after stopping the medication.
  • This medication does not permanently change your cycle.
  • This medication does not guarantee complete delay. Bleeding or spotting may still occur.

How do I take norethindrone for period delay?

  • You must start norethindrone at least 3 days before your expected period.
  • It is typically taken 3 times daily with meals for up to 10 days.
  • If bleeding has already started, norethindrone may not be effective at stopping it.
  • This medication should not be used more than once every 3 months unless directed by a clinician.

What side effects can occur?

  • Spotting or breakthrough bleeding
  • Bloating, mild cramping, or breast tenderness
  • Headache or nausea
  • Mood changes or irritability

What are the serious risks or warnings?

  • Norethindrone may slightly increase the risk of a blood clot, especially in patients with clotting risk factors.
  • You should not use this medication if you have a history of blood clots, stroke, certain cancers, or severe liver disease unless specifically cleared by your clinician.
  • Some medications and supplements may reduce effectiveness, including certain seizure medications, migraine treatments, and herbal products.

Does norethindrone prevent pregnancy?

No. Period delay medication is not contraception and does not prevent pregnancy. If pregnancy is possible, you should use reliable birth control or condoms.

When should I seek emergency care?

  • Chest pain, trouble breathing, or sudden shortness of breath
  • New leg swelling or pain (especially in one leg)
  • Sudden severe headache, vision changes, or weakness
  • Very heavy or uncontrolled bleeding
Period delay prescriptions are only provided when medically appropriate. Your clinician may decline or recommend in-person care if this service is not safe for you.

4C. Hormone Therapy (HRT) Informed Consent

What is hormone therapy used for?

Hormone therapy (HRT) may be prescribed to help manage symptoms related to perimenopause or menopause, including hot flashes, night sweats, sleep disruption, vaginal dryness, and other hormone-related symptoms. Treatment may include estrogen, progesterone, or a combination of both depending on your medical history and whether you have a uterus.

What should I know before starting HRT?

  • Hormone therapy can help relieve many menopausal symptoms but is not appropriate for every patient.
  • HRT is typically prescribed at the lowest effective dose for symptom control.
  • Treatment decisions depend on your age, health history, and individual risk factors.
  • Hormone therapy does not prevent aging and is not intended for long-term disease prevention.

What side effects may occur with HRT?

  • Breast tenderness
  • Bloating or mild fluid retention
  • Headache
  • Nausea
  • Irregular bleeding or spotting (especially during the first months of treatment)

What are the potential risks of hormone therapy?

  • A small increased risk of blood clots, stroke, or heart disease in certain patients.
  • Possible increased risk of breast cancer with long-term combined estrogen-progestin therapy.
  • Increased risk of uterine (endometrial) cancer if estrogen is taken without progesterone in patients who have a uterus. If you have a uterus, progesterone is required to protect the uterine lining. Never stop progesterone while continuing estrogen therapy unless directed by a clinician.
  • Hormone therapy may be unsafe in people with a history of certain cancers, blood clots, liver disease, or unexplained vaginal bleeding.

When should I seek urgent medical care?

  • Chest pain or trouble breathing
  • Sudden severe headache or vision changes
  • New leg swelling or pain
  • Sudden weakness or difficulty speaking
  • Severe or unusual vaginal bleeding

What follow-up may be needed?

  • Periodic medical follow-up may be required to reassess symptoms and safety.
  • You may be advised to maintain regular in-person preventive care including pelvic exams, breast screening (mammography), and routine health maintenance with your primary clinician or OB/Gyn.
  • Your clinician may adjust, discontinue, or decline hormone therapy if safety concerns arise.

Hormone therapy prescriptions are provided only when medically appropriate. Telemedicine evaluation may not replace in-person care, testing, or screening that may be recommended by your clinician.

5. Medications, Allergies & Pharmacy Responsibilities

What information must I provide about medications and allergies?

You agree to list all current medications, supplements, and allergies, including over-the-counter products and herbal remedies. This information is critical to avoid interactions and unsafe prescribing. You agree to update your list if anything changes.

What should I know about my pharmacy and prescriptions?

  • Prescriptions are sent electronically to the pharmacy you select.
  • Pharmacies may substitute generic versions or equivalent products when allowed by law and insurance.
  • Our services are cash-pay and may not be reimbursable by insurance. We do not participate with any insurance billing or reimbursement for commercial insurances and/or federal insurance plans (Medicaid). Medication cost, insurance coverage, and pharmacy stock are outside the control of MyBodyMyRx and your clinician.
  • You are responsible for contacting your pharmacy to confirm availability, price, and pick-up instructions.

Can prescriptions or refills be denied or changed?

Yes. A clinician may adjust the medication, dose, quantity, or duration, or may decline a prescription or refill if it is not medically appropriate, if follow-up is overdue, or if there are new or undisclosed safety concerns.

6. Messaging, Follow-Up & Visit Fees

What is included in my visit fee?

Each paid visit generally covers one evaluation and one treatment decision for a specific request (for example, birth control or emergency contraception), including brief follow-up clarification as needed. New or significantly changed concerns, new side effects, or requests for different medication may require a new visit and additional fee.

How are messages and follow-up handled?

  • Communication is primarily asynchronous (not in real time).
  • Messages are not monitored 24/7 and should not be used for emergencies.
  • Response times may vary depending on volume, time of day, and clinician availability.

Are medications included in the visit fee?

No. The visit fee covers telemedicine evaluation only. You are responsible for any separate charges at your pharmacy. Our services are cash-pay and may not be reimbursable by insurance. We do not participate with any insurance billing or reimbursement for commercial insurances and/or federal insurance plans (Medicaid). Insurance coverage, if any, is determined by your insurer and the pharmacy or facility, not by MyBodyMyRx.

Can I use my insurance or Medicaid?

MyBodyMyRx is a private, cash-pay telemedicine service. We do not accept Medicaid or any other insurance plans and do not submit claims for reimbursement. If you are enrolled in Medicaid, family planning services such as birth control or emergency contraception may be available to you at no cost through Medicaid-participating providers or clinics https://findahealthcenter.hrsa.gov/

7. Privacy, Records & Legal Acknowledgment

How are my records and privacy handled?

Your information is stored in an electronic medical record system with reasonable safeguards for privacy and security. Your information may be used and disclosed in accordance with applicable privacy laws and the MyBodyMyRx Privacy Policy and Terms of Service, which are available on this website.

What laws govern my care?

Care is provided only in states where clinicians are appropriately licensed, and is governed by the laws and regulations of the state in which you are physically located at the time of the visit, as well as applicable federal law.

What am I acknowledging legally by using this site?

  • You understand the benefits and limitations of telemedicine and consent to receive care in this way.
  • Your care is based on the information you provide; providing incomplete or inaccurate information can lead to incorrect or delayed diagnosis or treatment.
  • You understand that no outcome, result, or specific prescription is guaranteed.
  • You are responsible for following instructions, obtaining recommended tests or in-person evaluations, and seeking urgent or emergency care when needed.
By continuing to use MyBodyMyRx and submitting a visit request, you certify that you have read, understood, and voluntarily agree to this Patient Telemedicine & Medication Informed Consent and that you will ask questions if anything is unclear before proceeding.

8. Accessibility Statement

General

Dr. Isnetto, DNP, LLC, DBA MyBodyMyRx, strives to ensure that its services and website are accessible to people with disabilities. We believe that every person has the right to access healthcare information and services with dignity, equality, comfort, and independence.

We are continuously improving the accessibility of our website and digital services and aim to follow generally recognized accessibility standards and best practices.

Ongoing efforts and limitations

Despite our efforts to make all pages and content fully accessible, some content or features may not yet be fully adapted to the widest range of accessibility needs. This may be due to technological limitations or because the most appropriate solution has not yet been identified.

Accessibility is an ongoing process, and we regularly review and update our site to improve usability for all users.

Here for you

If you experience difficulty accessing any content on mybodymyrx.health or need assistance with any part of the website or telemedicine services, please contact us and we will make reasonable efforts to assist you as promptly as possible.

Can I use my insurance or Medicaid?

MyBodyMyRx is a private, cash-pay telemedicine service. We do not accept Medicaid or any other insurance plans and do not submit claims for reimbursement. If you are enrolled in Medicaid, family planning services such as birth control or emergency contraception may be available to you at no cost through Medicaid-participating providers or clinics https://findahealthcenter.hrsa.gov/

Accessibility support contact:
Email: support@mybodymyrx.health

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