I voluntarily consent to evaluation, consultation, and treatment by Rejuvenation Care Clinic and its licensed clinicians or authorized team members. I understand care may include history review, physical or telehealth evaluation, lab review, prescriptions when clinically appropriate, wellness planning, follow-up recommendations, and related services. I understand no specific outcome can be guaranteed and that treatments, medications, supplements, and recommendations may have risks, benefits, and alternatives. I agree to provide accurate health information and update the clinic if my health status, medications, allergies, pregnancy status, or other relevant information changes.

I consent to receive healthcare services through telehealth when clinically appropriate, including video visits, phone calls, secure messaging, digital forms, remote monitoring, and electronic review of health information. I understand telehealth has benefits and limitations. Technology issues, poor connection, incomplete information, or the need for hands-on examination may require an in-person visit or referral. Telehealth is not for emergencies; if I experience a medical emergency, I should call 911 or go to the nearest emergency room. I understand I must be physically located in a state where the clinician is authorized to provide care at the time of service.

I understand I am financially responsible for services, products, memberships, labs, medications, supplements, shipping charges, missed appointment fees, balances, and other fees not covered by insurance or not billed to insurance by Rejuvenation Care Clinic. Payment may be required before or at the time of service. I authorize Rejuvenation Care Clinic or its payment processor to charge my card on file for agreed-upon services and balances. Final fee, cancellation, refund, and membership terms will be provided by the clinic.

I consent to receive communications from Rejuvenation Care Clinic by phone, voicemail, SMS/text message, and email for appointment reminders, scheduling, care coordination, billing reminders, follow-up instructions, forms, and clinic updates. I understand SMS and standard email may not be fully secure and are not for emergencies or urgent medical concerns. I may opt out of non-essential messages at any time.

I acknowledge that Rejuvenation Care Clinic has made its Notice of Privacy Practices available to me. The Notice explains how my health information may be used and disclosed and describes my rights regarding my health information. I understand I may request a copy at any time.