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CLARIA is a telehealth platform. Prescription products require an online consultation with a licensed clinician and are only dispensed if prescribed.
Legal

Informed Consent to Telehealth

Last updated 20 August 2026

Attorney review required. This document is a compliant-by-structure template. A healthcare regulatory attorney must review and adapt it for your entity, your states and your vendors before you rely on it or apply for LegitScript certification.

You must read and agree to this consent before a clinician can evaluate you on CLARIA. Your agreement is recorded with a timestamp.

What telehealth is

Telehealth is the delivery of healthcare using electronic communication rather than an in-person visit. On CLARIA this may include a written clinical questionnaire, secure messaging, laboratory results, and audio or video visits.

Benefits

Access to a licensed clinician without travel, faster access to care, and ongoing follow-up through secure messaging.

Risks and limitations

Your rights

Participation is voluntary. You may withhold or withdraw consent at any time without affecting your right to future care, and may ask for an in-person referral at any time. You have the same confidentiality rights as an in-person visit.

Recording and records

Your telehealth interactions are documented in your medical record. Visits are not recorded without your separate written consent.

Emergencies

Telehealth is not appropriate for emergencies. If your condition becomes an emergency, call 911 or go to the nearest emergency room.

Your agreement

By checking the consent box before your assessment, you confirm you have read and understood this document, have had the opportunity to ask questions, and consent to receive care via telehealth.

Contact

__PLACEHOLDER_LEGAL_ENTITY__, __PLACEHOLDER_PHYSICAL_ADDRESS__. Email __PLACEHOLDER_SUPPORT_EMAIL__. Phone __PLACEHOLDER_SUPPORT_PHONE__.

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