Treatment Consent

HAIR LOSS TREATMENT

I have read the FDA drug information regarding finasteride, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that while hair thinning/baldness is often related to age induced follicular sensitivity, there are many medical conditions may lead to hair loss, and often require a physical medical exam and/or laboratory blood analysis to diagnose etiology, which I have not yet been evaluated for while utilizing the telehealth platform. I understand that Finasteride will treat the “symptom” of hair loss if taken as directed. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

SKIN RESTORATION

I have read the FDA drug information regarding Retin-A, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that while acne and wrinkle are often related to many other medical conditions, and often require a physical medical exam and/or laboratory blood analysis to diagnose which I have not yet been evaluated for. I understand that Retin-A will treat the “symptom” of acne and/or fine wrinkles if taken as directed. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

HAIR LOSS TREATMENT

SKIN RESTORATION

PREMATURE EJACULATION

TESTOSTERONE THERAPY

MEDICAL WEIGHT LOSS

EYELASH GROWTH

ERECTILE DYSFUNCTION

PREMATURE EJACULATION

I have read the FDA drug information regarding Paroxetine Hydrochloride, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that there are many medical conditions that may lead to premature ejaculation, and often require a physical medical exam and/or laboratory blood analysis to diagnose, which I have not yet been evaluated for. I understand that Paroxetine Hydrochloride will treat the “symptom” of premature ejaculation if taken as directed. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for a refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

TESTOSTERONE THERAPY

I have read the FDA drug information regarding Testosterone Cypionate, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that while low testosterone is often related to many other medical conditions, and often requires a physical medical exam and/or laboratory blood analysis to diagnose which I have not yet been evaluated for. I understand that Testosterone Cypionate will treat the “symptom” of low testosterone levels if taken as directed. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for a refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

MEDICAL WEIGHT LOSS

I have read the FDA drug information regarding Semaglutide, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that while Diabetes/weight problems/obesity are often related to many other medical conditions, and may require a comprehensive in-person physical medical exam and/or laboratory blood analysis to further diagnose which I have not yet been evaluated for. I understand that Semaglutide will treat diabetes and the “symptom” of obesity if taken as directed.  Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

EYELASH GROWTH

I have read the FDA drug information regarding Bimatoprost, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that while short eyelashes are often related to many other medical conditions, and often require a physical medical exam and/or laboratory blood analysis to diagnose which I have not yet been evaluated for. I understand that Bimatoprost will treat the “symptom” of short eye lashes if taken as directed. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

NAIL FUNGUS

I have read the FDA drug information regarding terbinafine, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that while nail fungus is often related to many other medical conditions, and often requires a physical medical exam and/or laboratory blood analysis to diagnose which I have not yet been evaluated for. I understand that terbinafine will treat the “symptom” of nail fungus if taken as directed. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for a refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

ERECTILE DYSFUNCTION

I have read the FDA drug information regarding Tadalafil and Sildenafil, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that there are many medical conditions that may lead to erectile dysfunction, and often require a physical medical exam and/or laboratory blood analysis to diagnose, which I have not yet been evaluated for. I understand that sildenafil and tadalafil will treat the “symptom” of erectile dysfunction if taken as directed. Since erectile dysfunction can be a sign of cardiovascular disease or other medical conditions such as testosterone deficiency, it may be important to identify “at-risk patients” who may benefit from specific counseling, and/or be necessary to perform an “in-person” consultation vs that of telehealth.  Since ED is very generally associated with cardiovascular risk, all ED patients to inquire regarding the relationship of ED with cardiovascular health, and the importance of meeting with a healthcare provider regularly for cardiovascular assessment and management.  Some examples of other specific risk factors include Diabetes, low testosterone, cigarette smoking, and stress reduction. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for a refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

HAIR LOSS TREATMENT

SKIN RESTORATION

PREMATURE EJACULATION

TESTOSTERONE THERAPY

MEDICAL WEIGHT LOSS

EYELASH GROWTH

ERECTILE DYSFUNCTION

SKIN RESTORATION

I have read the FDA drug information regarding Retin-A, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that acne and wrinkle are often related to many other medical conditions, and often require a physical medical exam and/or laboratory blood analysis to diagnose which I have not yet been evaluated for. I understand that Retin-A will treat the “symptom” of acne and/or fine wrinkles if taken as directed. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for a refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

PREMATURE EJACULATION

I have read the FDA drug information regarding Paroxetine Hydrochloride, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that there are many medical conditions may lead to premature ejaculation, and often require a physical medical exam and/or laboratory blood analysis to diagnose, which I have not yet been evaluated for. I understand that Paroxetine Hydrochloride will treat the “symptom” of premature ejaculation if taken as directed. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

TESTOSTERONE THERAPY

I have read the FDA drug information regarding Testosterone Cypionate, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that low testosterone is often related to many other medical conditions, and often requires a physical medical exam and/or laboratory blood analysis to diagnose which I have not yet been evaluated for. I understand that Testosterone Cypionate will treat the “symptom” of low testosterone levels if taken as directed. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for a refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

MEDICAL WEIGHT LOSS

I have read the FDA drug information regarding Semaglutide, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that Diabetes/weight problems/obesity are often related to many other medical conditions, and may require a comprehensive in-person physical medical exam and/or laboratory blood analysis to further diagnose which I have not yet been evaluated for. I understand that Semaglutide will treat diabetes and the “symptom” of obesity if taken as directed.  Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for a refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

EYELASH GROWTH

I have read the FDA drug information regarding Bimatoprost, and I understand both the therapeutic benefits as well as risks/side effects that may occur with such therapy. I understand that while short eyelashes are often related to many other medical conditions, and often require a physical medical exam and/or laboratory blood analysis to diagnose which I have not yet been evaluated for. I understand that Bimatoprost will treat the “symptom” of short eyelashes if taken as directed. Additionally, I understand the refund policy of Click Healthcare AZ, in that fulfilled orders are not eligible for a refund. If my treatment order is unable to be filled because it was deemed so by the medical provider, I am eligible for a refund under that circumstance

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