TELEHEALTH INFORMED CONSENT
Effective Date: January 25, 2026
This Telehealth Informed Consent (“Consent”) applies to services provided through Lavena Well, a brand operating as Lavena Wellness, which is a DBA of REJUVIMEN LLC (“Company,” “we,” “us,” or “our”).
IMPORTANT NOTICE
BY CLICKING “I AGREE,” CHECKING A BOX, SUBMITTING A FORM, CREATING AN ACCOUNT, SCHEDULING A VISIT, OR OTHERWISE USING OUR SERVICES, YOU ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND VOLUNTARILY AGREED TO THIS TELEHEALTH CONSENT IN FULL.
IF YOU DO NOT AGREE, DO NOT USE THE SERVICES.
YOU FURTHER AGREE THAT ANY PERSON WHO CLICKS “I AGREE” OR OTHERWISE ACCEPTS THIS CONSENT ON YOUR BEHALF HAS AUTHORITY TO DO SO.
⚠️ THIS SERVICE IS NOT FOR EMERGENCIES.
If you are experiencing a medical emergency, call 911 immediately.
If you are experiencing suicidal thoughts, call the 988 Suicide & Crisis Lifeline by dialing 988.
PURPOSE OF TELEHEALTH
Telehealth involves the use of electronic communications and technology to provide healthcare services when the patient and provider are not in the same physical location.
By agreeing to this Consent, you authorize licensed physicians, nurse practitioners, physician assistants, and other healthcare professionals (“Providers”) to provide medical services to you using telehealth technologies through platforms selected by the Company.
This Consent applies to all telehealth services provided now or in the future.
NATURE OF TELEHEALTH SERVICES
Telehealth services may include, but are not limited to:
Review of medical history and health information
Evaluation, diagnosis, treatment, and follow-up care
Prescription of medications, when legally permissible
Secure messaging and asynchronous communications
Audio and/or video consultations
Review of images, recordings, test results, and questionnaires
Remote monitoring and patient education
You understand that telehealth does not replace in-person medical care and that in-person alternatives are available.
ANTICIPATED BENEFITS
Potential benefits of telehealth include:
Convenient access to care without travel
Increased continuity of care
Reduced delays in evaluation
Greater privacy and flexibility
Improved engagement with treatment
However, no specific medical outcomes are guaranteed.
POTENTIAL RISKS & LIMITATIONS
You acknowledge and accept the following risks and limitations:
Providers cannot perform physical exams or emergency interventions
Delays or interruptions due to technical failures
Incomplete or inaccurate information may affect care decisions
Limitations in diagnosis without in-person testing
Risk of data breaches despite security safeguards
Prescribing limitations based on state and federal law
Possible need for referral to in-person or emergency care
You agree that the Company is not responsible for outcomes resulting from the inherent limitations of telehealth.
PATIENT RESPONSIBILITIES
You agree to:
Provide accurate, complete, and truthful health information
Update information promptly if conditions change
Follow Provider instructions
Use the service only while physically located in a jurisdiction where the Provider is licensed
Seek emergency or in-person care when advised
Failure to comply may result in termination of services.
EMERGENCIES & FOLLOW-UP CARE
Telehealth services are NOT appropriate for emergencies.
Do NOT rely on messaging or virtual visits for urgent or life-threatening issues
Providers may not respond immediately
You must seek emergency care independently when necessary
The Company assumes no liability for delays in care due to misuse of telehealth services.
PRIVACY & DATA SECURITY
We use commercially reasonable safeguards to protect your health information in accordance with applicable law, including HIPAA.
However, no system is 100% secure, and you acknowledge:
Electronic communications carry inherent risks
Email, SMS, or third-party platforms may not be fully secure
The Company is not liable for breaches outside its reasonable control
Your information may be disclosed as required for treatment, billing, operations, legal compliance, or public safety.
LAB TESTS & THIRD-PARTY SERVICES
Some services may require laboratory testing or third-party diagnostics.
You acknowledge that:
Tests may produce false, inconclusive, or inaccurate results
Sample collection errors may occur
The Company is not responsible for third-party failures
Providers may require additional testing or in-person evaluation
NO GUARANTEES & DISCLAIMER
Medical outcomes are not guaranteed
Telehealth is provided “AS IS” and “AS AVAILABLE”
The Company makes no warranties, express or implied
LIMITATION OF LIABILITY
TO THE MAXIMUM EXTENT PERMITTED BY LAW:
THE COMPANY SHALL NOT BE LIABLE FOR INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES
TOTAL LIABILITY SHALL NOT EXCEED THE AMOUNT PAID BY YOU FOR SERVICES IN THE PRIOR 12 MONTHS
YOU WAIVE ANY CLAIMS ARISING FROM TELEHEALTH LIMITATIONS, TECH FAILURES, OR THIRD-PARTY SERVICES
ARBITRATION & WAIVER OF LAWSUITS
YOU AGREE THAT ANY DISPUTE ARISING OUT OF OR RELATING TO THIS CONSENT OR TELEHEALTH SERVICES SHALL BE RESOLVED BY BINDING ARBITRATION, NOT IN COURT.
NO CLASS ACTIONS
NO JURY TRIAL
Arbitration shall occur in Hillsborough County, Florida
Governed by Florida law
GOVERNING LAW & VENUE
This Consent shall be governed by the laws of the State of Florida, without regard to conflict-of-law principles.
CONTACT INFORMATION
Lavena Well / Lavena Wellness
DBA of REJUVIMEN LLC
📍 5340 E 131st Ave, Suite 106
Temple Terrace, FL 33617
ACKNOWLEDGMENT
By using Lavena Well’s telehealth services, you confirm that:
You have read and understood this Consent
You voluntarily agree to telehealth care
You accept all risks and limitations
You release the Company to the fullest extent allowed by law
TELEHEALTH INFORMED CONSENT
Effective Date: January 25, 2026
This Telehealth Informed Consent (“Consent”) applies to services provided through Lavena Well, a brand operating as Lavena Wellness, which is a DBA of REJUVIMEN LLC (“Company,” “we,” “us,” or “our”).
IMPORTANT NOTICE
BY CLICKING “I AGREE,” CHECKING A BOX, SUBMITTING A FORM, CREATING AN ACCOUNT, SCHEDULING A VISIT, OR OTHERWISE USING OUR SERVICES, YOU ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND VOLUNTARILY AGREED TO THIS TELEHEALTH CONSENT IN FULL.
IF YOU DO NOT AGREE, DO NOT USE THE SERVICES.
YOU FURTHER AGREE THAT ANY PERSON WHO CLICKS “I AGREE” OR OTHERWISE ACCEPTS THIS CONSENT ON YOUR BEHALF HAS AUTHORITY TO DO SO.
⚠️ THIS SERVICE IS NOT FOR EMERGENCIES.
If you are experiencing a medical emergency, call 911 immediately.
If you are experiencing suicidal thoughts, call the 988 Suicide & Crisis Lifeline by dialing 988.
PURPOSE OF TELEHEALTH
Telehealth involves the use of electronic communications and technology to provide healthcare services when the patient and provider are not in the same physical location.
By agreeing to this Consent, you authorize licensed physicians, nurse practitioners, physician assistants, and other healthcare professionals (“Providers”) to provide medical services to you using telehealth technologies through platforms selected by the Company.
This Consent applies to all telehealth services provided now or in the future.
NATURE OF TELEHEALTH SERVICES
Telehealth services may include, but are not limited to:
Review of medical history and health information
Evaluation, diagnosis, treatment, and follow-up care
Prescription of medications, when legally permissible
Secure messaging and asynchronous communications
Audio and/or video consultations
Review of images, recordings, test results, and questionnaires
Remote monitoring and patient education
You understand that telehealth does not replace in-person medical care and that in-person alternatives are available.
ANTICIPATED BENEFITS
Potential benefits of telehealth include:
Convenient access to care without travel
Increased continuity of care
Reduced delays in evaluation
Greater privacy and flexibility
Improved engagement with treatment
However, no specific medical outcomes are guaranteed.
POTENTIAL RISKS & LIMITATIONS
You acknowledge and accept the following risks and limitations:
Providers cannot perform physical exams or emergency interventions
Delays or interruptions due to technical failures
Incomplete or inaccurate information may affect care decisions
Limitations in diagnosis without in-person testing
Risk of data breaches despite security safeguards
Prescribing limitations based on state and federal law
Possible need for referral to in-person or emergency care
You agree that the Company is not responsible for outcomes resulting from the inherent limitations of telehealth.
PATIENT RESPONSIBILITIES
You agree to:
Provide accurate, complete, and truthful health information
Update information promptly if conditions change
Follow Provider instructions
Use the service only while physically located in a jurisdiction where the Provider is licensed
Seek emergency or in-person care when advised
Failure to comply may result in termination of services.
EMERGENCIES & FOLLOW-UP CARE
Telehealth services are NOT appropriate for emergencies.
Do NOT rely on messaging or virtual visits for urgent or life-threatening issues
Providers may not respond immediately
You must seek emergency care independently when necessary
The Company assumes no liability for delays in care due to misuse of telehealth services.
PRIVACY & DATA SECURITY
We use commercially reasonable safeguards to protect your health information in accordance with applicable law, including HIPAA.
However, no system is 100% secure, and you acknowledge:
Electronic communications carry inherent risks
Email, SMS, or third-party platforms may not be fully secure
The Company is not liable for breaches outside its reasonable control
Your information may be disclosed as required for treatment, billing, operations, legal compliance, or public safety.
LAB TESTS & THIRD-PARTY SERVICES
Some services may require laboratory testing or third-party diagnostics.
You acknowledge that:
Tests may produce false, inconclusive, or inaccurate results
Sample collection errors may occur
The Company is not responsible for third-party failures
Providers may require additional testing or in-person evaluation
NO GUARANTEES & DISCLAIMER
Medical outcomes are not guaranteed
Telehealth is provided “AS IS” and “AS AVAILABLE”
The Company makes no warranties, express or implied
LIMITATION OF LIABILITY
TO THE MAXIMUM EXTENT PERMITTED BY LAW:
THE COMPANY SHALL NOT BE LIABLE FOR INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES
TOTAL LIABILITY SHALL NOT EXCEED THE AMOUNT PAID BY YOU FOR SERVICES IN THE PRIOR 12 MONTHS
YOU WAIVE ANY CLAIMS ARISING FROM TELEHEALTH LIMITATIONS, TECH FAILURES, OR THIRD-PARTY SERVICES
ARBITRATION & WAIVER OF LAWSUITS
YOU AGREE THAT ANY DISPUTE ARISING OUT OF OR RELATING TO THIS CONSENT OR TELEHEALTH SERVICES SHALL BE RESOLVED BY BINDING ARBITRATION, NOT IN COURT.
NO CLASS ACTIONS
NO JURY TRIAL
Arbitration shall occur in Hillsborough County, Florida
Governed by Florida law
GOVERNING LAW & VENUE
This Consent shall be governed by the laws of the State of Florida, without regard to conflict-of-law principles.
CONTACT INFORMATION
Lavena Well / Lavena Wellness
DBA of REJUVIMEN LLC
📍 5340 E 131st Ave, Suite 106
Temple Terrace, FL 33617
ACKNOWLEDGMENT
By using Lavena Well’s telehealth services, you confirm that:
You have read and understood this Consent
You voluntarily agree to telehealth care
You accept all risks and limitations
You release the Company to the fullest extent allowed by law
