1 Truthfulness and Accuracy

I certify that I have answered all questions in this medical survey truthfully, accurately, and completely, to the best of my knowledge. I understand that providing false, misleading, incomplete, or inaccurate information could result in an inappropriate treatment plan, severe adverse health outcomes, or ineffective medication.

2 Release of Liability

I agree that RX Authorized, its parent companies, affiliates, licensed medical providers, and partner pharmacies cannot and will not be held liable, legally or financially, for any injury, adverse reaction, complications, or lack of efficacy resulting from treatment prescribed based on incorrect, omitted, or misleading information provided by me.

3 No In-Person Examination & Provider Type

I acknowledge that the medical providers relying on this information are doing so via a telehealth platform without the benefit of an in-person physical examination, making my complete and honest disclosure absolutely critical to my safety. I understand that Florida law expressly permits patient evaluation via telehealth without a physical examination when such evaluation is sufficient to diagnose and treat. I further acknowledge that my treating provider may be a physician, physician assistant, or nurse practitioner, and I consent to receiving care from a non-physician provider where applicable.

4 Technology & Geographic Acknowledgment

I acknowledge that telehealth services depend on internet connectivity, video, and audio transmission, which may fail, degrade, be interrupted, contain bugs or other errors, produce erroneous results, render services unavailable or inoperable, cause records to be corrupted or lost, or cause communications to be delayed or lost. I confirm that I am physically located in a state where the assigned medical provider is licensed to practice at the time of this consultation, and I agree to notify RX Authorized immediately if I relocate to another state during the course of treatment.

5 Emergency Protocol

I understand that this telehealth service is not intended for medical emergencies. If I am experiencing a medical emergency, severe symptoms, or suicidal thoughts, I will call 911 or the 988 Suicide and Crisis Lifeline immediately. I will not rely on RX Authorized or its providers for emergency care.

6 Assumption of Risk

I voluntarily assume all risks associated with any treatment or prescription granted based on the information I have provided in this form, including but not limited to medication side effects, lack of efficacy, complications arising from the absence of an in-person physical examination, and technology-related errors, bugs, interruptions, or data corruption.

7 Florida Telehealth Acknowledgment

8 HIPAA & Corporate Structure

9 Florida Security of Communications Act (FSCA) Consent — Chatbot & Tracking

I acknowledge that the RX Authorized website may use chatbots, automated messaging tools, session replay software, analytics tracking pixels, and similar technologies that capture my interactions, keystrokes, form inputs, mouse movements, and page views. Florida law requires all parties to consent to the recording of communications. By checking this box, I explicitly consent to the recording, monitoring, and analysis of my interactions with the RX Authorized website, including any text I enter into chatbots or forms. I understand that any information provided by automated chatbots is for informational and administrative purposes only and does not constitute medical advice.

10 Certification

I certify that all information provided is truthful and accurate. I agree and understand that RX Authorized is not responsible for outcomes resulting from incorrect information, technical failures, errors, bugs, or data corruption, or my failure to disclose my true physical location. I have read and understand all of the above provisions and agree to be bound by them.