Telemedicine Consent
REBL LLC
Effective Date: December 30, 2025
Telemedicine is the delivery of healthcare services when the patient and the healthcare provider are not in the same physical location and communicate through electronic means. By using REBL’s telehealth services, you acknowledge and agree to the following terms.
1. Nature of Telemedicine
Telemedicine services may include, but are not limited to:
Medical history review and health questionnaires
Evaluation, assessment, and diagnosis
Treatment planning and follow-up care
Prescribing medications when medically appropriate
Education and counseling
Telemedicine services are provided using secure audio, video, and/or electronic communication technologies.
2. Not a Substitute for Emergency Care
REBL does not provide emergency or urgent medical services.
If you believe you are experiencing a medical emergency, you must call 911 or seek immediate care from the nearest emergency department. You should not rely on telehealth services for emergency situations.
3. Voluntary Participation & Alternatives
Your participation in telemedicine is voluntary.
You understand that:
You may choose to seek in-person medical care instead of telemedicine
A provider may determine that telemedicine is not appropriate for your condition
A provider may recommend in-person evaluation, laboratory testing, imaging, or referral to another clinician
4. Potential Benefits of Telemedicine
Potential benefits may include:
Improved access to care
Convenience and reduced travel
Timely evaluation and follow-up
5. Potential Risks and Limitations
You understand and acknowledge the potential risks of telemedicine, which may include:
Information transmitted may be less complete than in an in-person visit
Technical failures may delay or interrupt care
Limitations in physical examination may affect clinical decision-making
Despite reasonable safeguards, there is a risk of privacy or security breach
6. Privacy & Protected Health Information (PHI)
Telemedicine services often involve the electronic transmission of health information.
REBL and its clinical partners take reasonable steps to protect the privacy and security of your information and comply with applicable healthcare privacy laws, including HIPAA, when required.
Use and disclosure of Protected Health Information may be governed by a separate Notice of Privacy Practices, which will be made available to you when applicable.
7. Provider Relationship & Medical Decision-Making
You understand that:
Medical care is provided by licensed healthcare providers
All medical decisions are made by the provider based on professional judgment and applicable law
No diagnosis, treatment plan, or prescription is guaranteed
8. Prescriptions
If a provider determines that medication is medically appropriate:
A prescription may be issued following a clinical evaluation
There is no guarantee that medication will be prescribed
Prescriptions are issued only in compliance with state and federal law
You may request that a prescription be sent to a pharmacy of your choice or elect fulfillment through a licensed partner pharmacy.
9. State Location Requirement
You represent and agree that:
You will be physically located in the state you report at the time of each telehealth visit
Telehealth services may be declined or rescheduled if you are not located in an eligible state
Availability of specific treatments may vary by state
10. Right to Withdraw Consent
You may withdraw your consent to receive telemedicine services at any time by discontinuing use of the platform or notifying REBL.
Withdrawal of consent will not affect your right to future care, but it may limit the manner in which services can be provided.
11. Financial Responsibility
You understand and agree that:
REBL does not accept insurance unless explicitly stated
You are responsible for payment of all fees disclosed prior to receiving services
Fees for telehealth services are due regardless of whether medication is prescribed
12. Consent Acknowledgment
By proceeding with REBL’s telehealth services, you confirm that:
You have read and understand this Telemedicine Consent
You have had the opportunity to ask questions
All questions have been answered to your satisfaction
You voluntarily consent to receive healthcare services via telemedicine
Contact Information
If you have questions about telemedicine services or this consent, contact:
REBL LLC
1671 W Horizon Ridge Pkwy Ste 220
Henderson, NV 89012
Email: help@refill.co
REBL LLC
Effective Date: December 30, 2025
Telemedicine is the delivery of healthcare services when the patient and the healthcare provider are not in the same physical location and communicate through electronic means. By using REBL’s telehealth services, you acknowledge and agree to the following terms.
1. Nature of Telemedicine
Telemedicine services may include, but are not limited to:
Medical history review and health questionnaires
Evaluation, assessment, and diagnosis
Treatment planning and follow-up care
Prescribing medications when medically appropriate
Education and counseling
Telemedicine services are provided using secure audio, video, and/or electronic communication technologies.
2. Not a Substitute for Emergency Care
REBL does not provide emergency or urgent medical services.
If you believe you are experiencing a medical emergency, you must call 911 or seek immediate care from the nearest emergency department. You should not rely on telehealth services for emergency situations.
3. Voluntary Participation & Alternatives
Your participation in telemedicine is voluntary.
You understand that:
You may choose to seek in-person medical care instead of telemedicine
A provider may determine that telemedicine is not appropriate for your condition
A provider may recommend in-person evaluation, laboratory testing, imaging, or referral to another clinician
4. Potential Benefits of Telemedicine
Potential benefits may include:
Improved access to care
Convenience and reduced travel
Timely evaluation and follow-up
5. Potential Risks and Limitations
You understand and acknowledge the potential risks of telemedicine, which may include:
Information transmitted may be less complete than in an in-person visit
Technical failures may delay or interrupt care
Limitations in physical examination may affect clinical decision-making
Despite reasonable safeguards, there is a risk of privacy or security breach
6. Privacy & Protected Health Information (PHI)
Telemedicine services often involve the electronic transmission of health information.
REBL and its clinical partners take reasonable steps to protect the privacy and security of your information and comply with applicable healthcare privacy laws, including HIPAA, when required.
Use and disclosure of Protected Health Information may be governed by a separate Notice of Privacy Practices, which will be made available to you when applicable.
7. Provider Relationship & Medical Decision-Making
You understand that:
Medical care is provided by licensed healthcare providers
All medical decisions are made by the provider based on professional judgment and applicable law
No diagnosis, treatment plan, or prescription is guaranteed
8. Prescriptions
If a provider determines that medication is medically appropriate:
A prescription may be issued following a clinical evaluation
There is no guarantee that medication will be prescribed
Prescriptions are issued only in compliance with state and federal law
You may request that a prescription be sent to a pharmacy of your choice or elect fulfillment through a licensed partner pharmacy.
9. State Location Requirement
You represent and agree that:
You will be physically located in the state you report at the time of each telehealth visit
Telehealth services may be declined or rescheduled if you are not located in an eligible state
Availability of specific treatments may vary by state
10. Right to Withdraw Consent
You may withdraw your consent to receive telemedicine services at any time by discontinuing use of the platform or notifying REBL.
Withdrawal of consent will not affect your right to future care, but it may limit the manner in which services can be provided.
11. Financial Responsibility
You understand and agree that:
REBL does not accept insurance unless explicitly stated
You are responsible for payment of all fees disclosed prior to receiving services
Fees for telehealth services are due regardless of whether medication is prescribed
12. Consent Acknowledgment
By proceeding with REBL’s telehealth services, you confirm that:
You have read and understand this Telemedicine Consent
You have had the opportunity to ask questions
All questions have been answered to your satisfaction
You voluntarily consent to receive healthcare services via telemedicine
Contact Information
If you have questions about telemedicine services or this consent, contact:
REBL LLC
1671 W Horizon Ridge Pkwy Ste 220
Henderson, NV 89012
Email: help@refill.co
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