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AXXIUMS

AUTHORIZATION TO USE AND DISCLOSE MEDICAL INFORMATION

INFORMED CONSENT TO TELEHEALTH

OPEN PAYMENTS NOTICE

Last Updated: April 29, 2026

By clicking “I Agree,” checking a related box, using any acceptance protocol presented through the Service, or otherwise affirmatively accepting this Consent, you acknowledge that you have read, understood, accepted, and agree to be bound by this Consent.

If you do not agree, do not create an account or use the Service.

If acceptance is completed by a legally authorized representative on your behalf, you authorize such person to act for you to the extent permitted by law.

IMPORTANT EMERGENCY NOTICE

AXXIUMS does not provide emergency services.

If you are experiencing a life-threatening emergency, thoughts of self-harm, suicidal thoughts, severe psychiatric distress, chest pain, difficulty breathing, or any urgent medical condition:

  • Call 911

  • Go to the nearest emergency room

  • Call or text 988 Suicide & Crisis Lifeline

Do not rely on website messages, email, or telehealth communications for emergencies.

1. PURPOSE OF THIS CONSENT

The purpose of this Consent is to:

  • explain telehealth services;

  • obtain your informed consent for telehealth treatment;

  • authorize appropriate use and disclosure of medical information;

  • explain laboratory coordination services when applicable; and

  • provide legally required notices.

This Consent applies to services offered through AXXIUMS INC (“AXXIUMS,” “we,” “us,” or “our”), including affiliated platforms, clinicians, contractors, and service providers (collectively, the “Service”).

2. WHO “YOU” MEANS

“You,” “your,” and “yours” refer to:

  • the individual receiving Services; or

  • where permitted by law, the parent, guardian, or legally authorized representative acting on behalf of a minor or dependent adult.

For minors, state-specific consent laws apply.

3. PROVIDERS WHO MAY PARTICIPATE

Services may be delivered by appropriately licensed professionals, which may include:

  • Physicians

  • Nurse Practitioners

  • Physician Assistants

  • Psychiatrists

  • Therapists / Counselors

  • Psychologists

  • Registered Dietitians

  • Health Coaches

  • Sexual Wellness Educators

  • Other licensed or credentialed professionals as permitted by law

Not all provider types are available in all states.

4. WHAT TELEHEALTH IS

Telehealth involves healthcare or mental health services delivered using technology when you and your provider are not in the same physical location.

Telehealth may include:

  • video visits

  • phone visits

  • secure messaging

  • electronic questionnaires

  • review of uploaded records

  • remote monitoring data

  • care coordination

  • patient education

5. BENEFITS OF TELEHEALTH

Potential benefits may include:

  • increased access to licensed clinicians

  • convenience and reduced travel time

  • faster follow-up care

  • continuity of treatment

  • privacy and discretion

  • easier medication monitoring when appropriate

  • improved access to specialty services

No specific result is guaranteed.

6. RISKS AND LIMITATIONS OF TELEHEALTH

Potential risks include:

  • technology failures or interruptions

  • poor audio/video quality

  • delays in communication

  • inability to perform hands-on physical exams

  • incomplete information affecting diagnosis or treatment

  • privacy/security risks despite safeguards

  • need for in-person referral

  • state prescribing restrictions

  • clinical limitations of remote care

Mental health treatment may sometimes involve temporary emotional discomfort as issues are explored.

7. WHEN TELEHEALTH MAY NOT BE APPROPRIATE

Telehealth may not be appropriate for:

  • emergencies

  • severe psychiatric instability

  • chest pain / stroke symptoms

  • acute intoxication or withdrawal

  • conditions requiring immediate physical examination

  • situations requiring laboratory or imaging urgency

  • any issue your provider believes requires in-person care

Providers may decline or discontinue telehealth when clinically appropriate.

8. PROVIDER DISCRETION

Your clinician will independently determine whether:

  • diagnosis is appropriate

  • treatment is appropriate

  • medication is indicated

  • controlled substances are appropriate

  • lab testing is needed

  • specialist referral is needed

  • in-person care is required

No prescription, refill, stimulant medication, testosterone, GLP-1 medication, or other treatment is guaranteed.

9. CONTROLLED SUBSTANCES

Certain medications are subject to strict federal and state law.

If clinically indicated, providers may require:

  • identity verification

  • prior records

  • urine drug testing

  • pharmacy review

  • regular follow-up visits

  • treatment agreements

  • in-person referrals when required

Controlled substance treatment may be denied, modified, paused, or discontinued at any time when clinically or legally necessary.

10. LABORATORY TESTING SERVICES

Some services may involve laboratory testing ordered by a licensed provider.

Testing may include:

  • at-home collection kits

  • in-person blood draws

  • third-party laboratory processing

Risks of blood draws may include:

  • discomfort

  • bruising

  • redness

  • swelling

  • bleeding

  • lightheadedness

  • rare infection

Laboratory testing may produce:

  • false positives

  • false negatives

  • inconclusive findings

  • delayed results

AXXIUMS is not the testing laboratory and does not guarantee test accuracy.

You remain responsible for follow-up care and sharing results with your primary care clinician when appropriate.

11. AUTHORIZATION TO USE AND DISCLOSE MEDICAL INFORMATION

You authorize AXXIUMS and affiliated providers to use, receive, disclose, and exchange your medical and personal information as reasonably necessary for:

  • treatment

  • care coordination

  • prescriptions

  • pharmacy fulfillment

  • laboratory ordering/results

  • payment and billing

  • operations and quality improvement

  • legal compliance

  • safety monitoring

Information may be shared with pharmacies, laboratories, consultants, technology vendors, and others involved in your care, subject to applicable law.

12. PRIVACY AND SECURITY

AXXIUMS uses reasonable administrative, physical, and technical safeguards to protect your information.

However, no electronic system can guarantee absolute security.

You acknowledge risks inherent in:

  • email

  • text messaging

  • internet transmission

  • device compromise

  • third-party platform outages

Use of personal devices and email is at your own risk.

13. COMMUNICATIONS CONSENT

You consent to receive communications related to your care, including:

  • appointment reminders

  • follow-up messages

  • treatment instructions

  • billing notices

  • account notices

These may be sent by secure portal, email, phone, or text message where permitted.

14. PHARMACY NOTICE

AXXIUMS may coordinate with pharmacy partners for convenience.

You may request transfer of a valid prescription to a pharmacy of your lawful choice, subject to clinical judgment and applicable law.

Medication availability, insurance coverage, and pricing are not guaranteed.

15. FINANCIAL RESPONSIBILITY

You are responsible for all charges associated with Services unless otherwise stated in writing.

You agree not to improperly bill Medicare, Medicaid, or other payors for services not eligible for reimbursement.

16. YOUR ACKNOWLEDGMENTS

By accepting this Consent, you acknowledge that:

  • telehealth has risks and limitations;

  • alternatives may include in-person care;

  • no treatment outcome is guaranteed;

  • providers exercise independent medical judgment;

  • you may withdraw telehealth consent prospectively;

  • you must provide accurate health information;

  • inaccurate information may affect safety and treatment;

  • providers may refer you elsewhere if needed.

17. RIGHT TO WITHDRAW CONSENT

You may withdraw consent to telehealth at any time by written notice, subject to:

  • actions already taken in reliance on prior consent; and

  • understanding that some AXXIUMS services may only be available virtually.

Withdrawal does not erase prior lawful disclosures or completed care.

18. OPEN PAYMENTS NOTICE

For informational purposes only:

The federal Open Payments program requires reporting of certain payments or transfers of value from drug, device, and biologics manufacturers to physicians and teaching hospitals.

The public database is available at:https://openpaymentsdata.cms.gov

19. STATE LICENSING NOTICE

Providers practice only where licensed or otherwise authorized.

For licensing questions or complaints, contact your state licensing board.

Virginia consumers may visit: Virginia Medical Board of Medicine

Maryland consumers may visit: Maryland medical and Nursing Board

 

20. CONTACT INFORMATION

AXXIUMS INC
1301 West 7th Street Unit 1485
Frederick, MD 21702
Email: contact@axxiums.com

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