TELEHEALTH MEDICAL CONSENT

Testosterone Shots, PC (DBA: TestosteroneShotsCom)

Last Updated: April 20, 2026

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OUR PROVIDERS DO NOT ADDRESS MEDICAL EMERGENCIES. DO NOT USE THE TESTOSTERONE SHOTS PLATFORM IF YOU BELIEVE YOU ARE HAVING A MEDICAL EMERGENCY. IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL EMERGENCY, DIAL 9-1-1 AND/OR GO TO THE NEAREST EMERGENCY ROOM IMMEDIATELY.

IF YOU ARE CONTEMPLATING SUICIDE OR SELF-HARM, CONTACT 911 OR THE NATIONAL SUICIDE PREVENTION LIFELINE:

- DIAL 1-800-273-TALK (1-800-273-8255)

- DIAL OR TEXT 988

- CHAT LIVE AT 988Lifeline.org

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I. INTRODUCTION

You are reviewing and acknowledging this Telehealth Informed Consent because you are seeking Healthcare Services utilizing telehealth technologies facilitated through the Testosterone Shots Platform website, iOS mobile application, mobile web application, or other telehealth technologies (collectively, the "Testosterone Shots Platform").

This Telehealth Informed Consent does not modify or supersede any Terms of Service, Privacy Policy, or Notice of Privacy Practices of Testosterone Shots or the Providers. Rather, it supplements those terms and documents.

By creating an account, starting a consult, clicking "I consent to telehealth," checking a related box to signify your acceptance, or using any other acceptance protocol presented through the Testosterone Shots Platform, you indicate that you have reviewed the risks described herein of receiving services utilizing telehealth technologies and consent to receiving those services.

A record of this Telehealth Informed Consent is maintained in the files and records of the applicable Provider delivering your services. Your ongoing participation in services using telehealth technologies serves as an ongoing acknowledgement of your acceptance of this Telehealth Informed Consent.

Testosterone Shots, PC refers to a network of medical professional organizations affiliated with the Testosterone Shots Platform and its employed and contracted health providers (the "Providers").

II. WHAT IS TELEHEALTH?

Telehealth involves the delivery of health and wellness services using electronic communications, information technology, or other means between a licensed, certified, or registered healthcare professional at one location and a patient in another location regarding a clinical matter. Telehealth may be used for diagnosis, treatment, follow-up, and/or patient education.

These telehealth services may involve various modalities, including asynchronous interactions, real-time (synchronous) video and audio encounters, and interactive audio with store and forward technology.

This Telehealth Informed Consent informs you concerning the treatment methods, risks, and limitations of utilizing telehealth to meet your health and wellness needs.

III. WHAT ARE THE POSSIBLE BENEFITS OF TELEHEALTH?

Benefits of telehealth include easier and more efficient access to health and wellness services. You can obtain health and wellness services at times that are convenient for you without the necessity of an in-office appointment, including follow-up care related to your treatment.

If you need follow-up care or have questions, please contact us through the Testosterone Shots Platform or by calling 323-283-9219.

IV. WHAT ARE THE POSSIBLE RISKS OF TELEHEALTH?

Information transmitted to your healthcare professional may not be sufficient to allow for appropriate health or wellness services to meet your particular needs. Some clinical needs may not be appropriate for a telehealth visit and your Provider will make that determination.

The technology necessary to interact with your healthcare professional may fail and delay your services. If a technical failure prevents you from communicating with your Provider, please call 323-283-9219.

In rare circumstances, a lack of access to complete medical records and/or the quality of transmitted data could result in adverse drug interactions, allergic reactions, and/or other clinical judgment errors.

You may stop or decline any ongoing Healthcare Services provided by Testosterone Shots, PC using telehealth technologies at any time, although you acknowledge that applicable fees may apply if a medical consultation has already occurred. Testosterone Shots, PC has no obligation for your ongoing care or selection of separate healthcare services following cancellation.

Third-Party Laboratory Products and Services. To facilitate certain Healthcare Services, Providers may require that you complete diagnostic tests. These diagnostic tests are provided by third-party laboratories, and neither Testosterone Shots, Testosterone Shots, PC, nor your Provider(s) can guarantee the accuracy or reliability of these tests. Laboratory tests can produce false negative, false positive, or inconclusive results that could impact your Provider's ability to correctly diagnose or treat your medical conditions.

V. COMPOUNDED MEDICATIONS

Some treatments available through the Testosterone Shots Platform involve compounded medications prepared by state-licensed, DEA-registered compounding pharmacies. The following disclosures apply to compounded medications:

A. Not FDA-Approved. Compounded medications are not FDA-approved. This means the FDA has not evaluated compounded formulations for safety, efficacy, or quality in the same manner as commercially manufactured FDA-approved drugs. Compounded medications are prepared for individual patients based on a valid prescription from a licensed Provider.

B. Prepared by Third-Party Pharmacies. Compounded medications are prepared and shipped directly to you by independent, state-licensed compounding pharmacies. Testosterone Shots, PC does not manufacture, compound, handle, or ship any medications. The pharmacy, not Testosterone Shots, PC, is solely responsible for the quality and preparation of your compounded medication.

C. Risks of Compounded Medications. Compounded medications carry risks including, but not limited to: variability in potency, sterility concerns, and the absence of the same post-market surveillance applied to FDA-approved drugs. You should inform all of your healthcare providers, including your primary care provider, of any compounded medications you are taking.

D. Your Choice. You have the right to request that your prescription be filled at a pharmacy of your choice, including a standard retail pharmacy if a commercially available equivalent exists. You acknowledge that price, availability, and formulation may differ from what is offered through the Testosterone Shots Platform.

VI. HORMONE THERAPY AND TRT-SPECIFIC RISKS

If you are receiving testosterone replacement therapy (TRT) or other hormone-based treatments through the Testosterone Shots Platform, the following additional risks and disclosures apply:

A. General Hormone Therapy Risks. Hormone therapy may carry risks including, but not limited to: changes in red blood cell count (polycythemia), changes in cholesterol levels, acne or oily skin, fluid retention, mood changes, sleep apnea, reduced fertility or temporary suppression of natural testosterone production, testicular atrophy, and in rare cases, cardiovascular events. Your Provider will evaluate your individual risk profile before prescribing.

B. Fertility. Testosterone replacement therapy may significantly reduce sperm production and fertility. If you are planning to father children in the future, discuss this with your Provider before beginning treatment. Alternative therapies that preserve fertility may be available.

C. Ongoing Monitoring. Hormone therapy requires periodic laboratory monitoring to assess hormone levels, hematocrit, lipid panels, and other relevant biomarkers. Your Provider will advise you on the appropriate monitoring schedule. Failure to complete recommended labs may result in your Provider declining to continue prescribing.

D. Off-Label Use. Some treatments available through the Testosterone Shots Platform, including peptide therapies and other compounded formulations, may be prescribed for off-label uses — meaning uses not specifically approved by the FDA. Your Provider will explain the clinical rationale for any off-label recommendation.

E. Drug Interactions. You are responsible for disclosing all medications, supplements, and over-the-counter products you are currently taking. Failure to disclose may increase the risk of adverse drug interactions.

VII. PATIENT ACKNOWLEDGMENTS

By accepting this Telehealth Informed Consent, you acknowledge, understand, and consent to the following:

1. You have reviewed this Telehealth Informed Consent carefully and understand there are risks, limitations, and benefits of utilizing telehealth.

2. You understand that the electronic nature of telehealth services means there is a greater risk to the privacy of your health information.

3. In some cases, your Provider may be a nurse practitioner or physician assistant and not a physician.

4. Persons may be present during the telehealth visit other than your Provider in order to operate the telehealth technologies and/or for language translation assistance, if requested. If another person is present, you will be informed of that individual's presence and role.

5. You understand that information you provide as part of any telehealth offering is viewed as accurate, true, and complete. Providing inaccurate or incomplete information may affect the safety and appropriateness of your care.

6. You understand that in certain instances, and in compliance with applicable law, your Provider may determine it is appropriate to provide Healthcare Services asynchronously via store-and-forward technology. In such instances, your Provider and you will communicate electronically through the Testosterone Shots Platform and not via telephone or video. You agree to receive Healthcare Services in this manner if your Provider makes that determination.

7. You understand that there is no guarantee that you will be given a prescription, and that the decision of whether a prescription is appropriate will be made in the professional judgment of your Provider. While the use of telehealth may provide benefits, no specific results can be guaranteed and your condition may not improve.

8. You understand there is a risk of technical failures during the telehealth encounter beyond the control of Testosterone Shots, PC and your Provider(s). YOU AGREE TO HOLD HARMLESS TESTOSTERONE SHOTS, PC AND ITS EMPLOYEES, CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PREDECESSORS, AND SUCCESSORS, INCLUDING TESTOSTERONE SHOTS AND ITS EMPLOYEES, CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PARENTS, PREDECESSORS, AND SUCCESSORS FOR DELAYS IN EVALUATION OR FOR INFORMATION LOST DUE TO SUCH TECHNICAL FAILURES.

9. You understand that certain diagnostic testing services, including laboratory products and services offered through the Testosterone Shots Platform, may contain defects that could limit functionality or produce erroneous results, which could impact the quality, accuracy, and/or effectiveness of the medical care you receive.

10. You understand the Testosterone Shots Platform makes available a specific set of services and you may need to seek other resources for your other health needs. There is no guarantee that you will be approved for treatment by a Provider. Your Provider reserves the right to deny care for any reason if, in the professional judgment of your Provider, the provision of services via telehealth is not medically or ethically appropriate. The Providers, and not Testosterone Shots or Testosterone Shots, PC, are responsible for the quality and appropriateness of the care they render and make all decisions regarding clinical care in their independent discretion.

11. You understand that by using the Testosterone Shots Platform you are not always speaking or messaging with your Provider in real-time, and there may be a delay before your messages or information is reviewed. You must check the Testosterone Shots Platform for messages because this is the way your Provider will communicate important information to you.

12. You understand that you have the opportunity to discuss the use of telehealth with your Provider(s), including the benefits, risks, and alternatives. You have the right to withdraw your consent to the use of telehealth at any time, without prejudice to any future care or treatment and without risking the loss of any health benefits to which you are entitled. You understand that the Providers who deliver Healthcare Services via the Testosterone Shots Platform do not offer in-person treatment.

13. You understand that you have access to your medical record pertaining to the Healthcare Services of Providers utilizing the Testosterone Shots Platform in accordance with applicable laws and regulations, and that your primary care provider, or other treating provider, may obtain copies of your health and wellness information with your consent.

14. You understand that while the Testosterone Shots Platform may make available access to pharmacy or diagnostic lab services coordinated with your Healthcare Services, you are able to request any pharmacy or lab of your preference.

15. You have been informed that some medications available through this platform are compounded and are not FDA-approved. You have read and understood Section V (Compounded Medications) of this consent.

16. You agree that Testosterone Shots, PC is a third-party beneficiary of this Telehealth Informed Consent and has the right to enforce it against you.

VIII. ADDITIONAL STATE-SPECIFIC DISCLOSURES

The following disclosures apply to users accessing the Testosterone Shots Platform in the states listed below:

Iowa

I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website: https://medicalboard.iowa.gov/consumers/filing-complaint

Kentucky

I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website: https://kbml.ky.gov/grievances/Pages/default.aspx

Maine

I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website: https://www.maine.gov/md/complaint/file-complaint

New York

I have been informed that to get information regarding my rights and how to report professional misconduct, I should visit: https://www.health.ny.gov/professionals/doctors/conduct

Oregon

I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website: https://www.oregon.gov/omb/investigations/pages/how-to-file-a-complaint.aspx

Rhode Island

I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website: https://health.ri.gov/complaints/

Texas

NOTICE CONCERNING COMPLAINTS — Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018. Assistance in filing a complaint is available by calling 1-800-201-9353. For more information, please visit www.tmb.state.tx.us.

AVISO SOBRE LAS QUEJAS — Las quejas sobre médicos, así como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugía, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018. Si necesita ayuda para presentar una queja, llame al 1-800-201-9353. Para obtener más información, visite www.tmb.state.tx.us.

Vermont

I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website: http://www.healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint — or the Board of Osteopathic Examiners: https://sos.vermont.gov/opr/complaints-conduct-discipline/

Wyoming

I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website: http://wyomedboard.wyo.gov/consumers/file-a-complaint

IX. FLORIDA — INFORMED CONSENT RELATED TO TREATMENT OF WEIGHT LOSS CONDITIONS THROUGH TELEHEALTH

Pursuant to Florida Medical Board Rule, Standards for the Prescription of Drugs to Treat Obesity (64B8-9.012(5)), before prescribing, ordering, dispensing, or administering an anti-obesity drug, your Provider must obtain written informed consent discussing potential benefits versus potential risks of weight loss treatments.

Purpose. The purpose of this informed consent is to ensure you are aware of the potential benefits and risks of starting a weight-loss program. It is vitally important for you to advise your healthcare provider of ANY concerns, problems, complaints, symptoms, or questions so the provider team can determine the best course of treatment.

Potential Benefits.

Medically significant weight loss (generally about 10 percent of initial body weight) may:

- Lower blood pressure and reduce the risk of hypertension.

- Lower cholesterol and reduce the risk of heart and vascular disease.

- Lower blood sugar and reduce the risk of diabetes.

If you are taking medications for one or more of these conditions, dosages may need to be adjusted as your overall health improves. You agree to see your primary care provider, if you have one, as needed to have your need for these medications reassessed.

Other benefits may also be obtained but cannot be guaranteed. Increasing activity level can favorably affect the above conditions and may provide the additional benefit of helping you sustain weight loss. Weight loss and increased activity may also provide important psychological and social benefits.

Possible Side Effects and Risks.

Reduced Weight. When you reduce caloric intake below your daily energy expenditure, you lose weight. As a result, your body may make other adjustments in body processes. You may experience temporary side effects including: initial loss of body fluid through increased urination, momentary dizziness, reduced metabolic rate, sensitivity to cold, a slower heart rate, dry skin, fatigue, diarrhea or constipation, bad breath, muscle cramps, a change in menstrual pattern, or dry and brittle hair or hair loss. Generally, these responses are temporary and resolve when caloric intake is increased after the weight loss period.

Reduced Potassium Levels. Low potassium levels can cause serious heart irregularities. A rapid increase in calorie intake following a period of caloric restriction, especially overeating or binge-eating, can be associated with bloating, fluid retention, disturbances in salt and mineral balance, gallbladder attacks, and abdominal pain.

Gallstones. Overweight individuals develop gallstones at a higher rate than those at normal weight. Losing weight — especially rapidly — may increase the chances of developing gallstones or sludge within the gallbladder. The most common symptoms of gallstones are fever, nausea, and cramping pain in the right upper abdomen. If you develop these symptoms or suspect you may have gallstones, notify your provider team and primary care provider immediately. Gallbladder problems may require medication or surgery, and in rare cases may be associated with more serious complications including inflammation of the pancreas.

Pancreatitis. Pancreatitis, or inflammation of the pancreas, may be associated with gallstones and obstruction of the bile ducts. Symptoms include pain in the upper left abdominal area, nausea, and fever. Pancreatitis may be precipitated by binge-eating or consuming a large meal after a period of dieting, long-term alcohol abuse, and the use of certain medications. Pancreatitis may require surgery and may be associated with serious complications and death.

Pregnancy. If you become pregnant, immediately stop all weight loss medications and notify your healthcare team and primary care provider. Your diet must be changed promptly to avoid further weight loss, as a restricted diet could be harmful to a developing fetus. You must take precautions to avoid becoming pregnant during the course of weight loss treatment.

Binge Eating Disorders. Binge eating disorder is defined as the habitual, uncontrolled consumption of large amounts of food in a short period of time. Participation in a calorically restricted diet has been associated with temporary increases in binge eating episodes in some individuals.

Risk of Weight Regain. Obesity is a chronic condition, and the majority of individuals who lose weight tend to regain all or some of it over time. Factors that help maintain a reduced body weight include regular physical activity, adherence to a calorie-restricted diet, and a strategy for coping with weight regain. Successful treatment may take months or years.

Sudden Death. Patients with severe obesity, particularly those with serious hypertension, coronary artery disease, or diabetes mellitus, have a statistically higher risk of sudden death compared to normal-weight individuals without such medical problems.

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[email protected] | (323) 283-9219

638 1/2 N Robertson Blvd, West Hollywood, CA 90069