Revana Health, LLC provides clinical infrastructure and care coordination services. We are not a healthcare provider or medical practice. Clinical services are delivered by independent, licensed healthcare providers operating through affiliated professional medical entities in the states where they are licensed. By using the Services and signing this consent, you are consenting to receive healthcare services from those independent providers — not from Revana Health, LLC. Some states require you to sign or acknowledge this document before your consultation may begin.
Your Provider's Credentials
Your provider's license, credentials, and professional background are available through your patient profile prior to your consultation. If you have questions, direct them to your provider before the consultation begins. State-specific information about verifying credentials or filing a complaint is in the State Regulations section below.
About Telehealth — Benefits and Risks
Telehealth is the delivery of healthcare services through electronic communications between a licensed provider and a patient who are not in the same physical location. The platform uses encrypted communication protocols designed to protect the confidentiality and integrity of your health information. Potential benefits include convenient access to licensed providers from home, timely clinical evaluation, and access to specialists who may not be locally available. Potential risks include technical failures — such as dropped connections or poor audio or video quality — that could affect the quality or continuity of the consultation. In rare circumstances, a provider may determine the information transmitted is insufficient and recommend an in-person visit or rescheduled consultation. In-person alternatives to telehealth are always available.
Controlled Substances
Certain controlled substances may be available where permitted by federal and state law. Affiliated providers may prescribe Schedule III controlled substances, including testosterone for clinically diagnosed hypogonadism or hormone deficiency, and Schedule IV controlled substances, including phentermine for weight management, where authorized under the Ryan Haight Act, applicable DEA regulations, and state law. Schedule II controlled substances, opioids, and benzodiazepines are not available through this platform under any circumstances. Whether to prescribe any medication is determined solely by your treating provider.
Confidentiality and When It May Be Shared
Your health information is confidential and handled per our Privacy Policy, Notice of Privacy Practices, and applicable law. In limited circumstances, confidential information may be disclosed without your consent: when there is a credible threat of serious harm to you or an identifiable third party; when there is reasonable suspicion of abuse, neglect, or exploitation of a child or vulnerable adult; in response to a valid court order, subpoena, or legal process; to comply with mandatory reporting obligations; or as otherwise described in our Privacy Policy and Notice of Privacy Practices.
Fees and Payment
All services are provided on a cash-pay basis. We do not accept health insurance, Medicare, or Medicaid. Fees are due at the time of service. If you believe you have been charged incorrectly, notify us in writing at support@myrevana.com within 15 calendar days of the charge; failure to notify within this window constitutes acceptance of the charge.
Diagnostic and Laboratory Testing
Some services may require at-home diagnostic or laboratory tests provided by independent third-party laboratories. Neither Revana Health, LLC nor your provider can guarantee the accuracy or reliability of third-party laboratory results, which can produce false positive, false negative, or inconclusive results.
Your Consent — What You Are Agreeing To
By acknowledging this document electronically or signing, you confirm that you understand and agree that: you consent to receiving healthcare services through telehealth from the independent licensed providers affiliated with this platform, complementing but not replacing your relationship with your primary care provider; your provider will determine whether your needs are appropriate for telehealth and may refer you to in-person care; you have had the opportunity to review your provider's credentials; telehealth may involve electronic transmission of your health information across state lines; you agree to hold Revana Health, LLC and affiliated providers harmless for delays or loss of information resulting from technical failures beyond their reasonable control; you may withdraw consent to telehealth at any time without affecting your right to future care; in-person alternatives are available; others may be present to support platform operations and you may request they leave or that certain information be withheld; only Schedule III and IV controlled substances permitted under applicable law may be prescribed; you have the right to request a copy of your medical records at reasonable cost; and you have read the state-specific disclosures applicable to your state of residence below.
State Regulations
The following disclosures are required under the laws of specific states. Please read the disclosure applicable to your state of residence at the time of your telehealth encounter.
Alabama: Your provider may forward a copy of your medical records to your primary care physician. (Ala. Code § 34-24-503).
Alaska: Your primary care provider may obtain a copy of records from your telehealth encounter. (Alaska Stat. § 08.63.210(C)(2)).
Arizona: All medical records resulting from a telemedicine consultation are part of your medical record. (Ariz. Rev. Stat. Ann. § 36-3602(D)).
Arkansas: Your provider will obtain informed consent for telehealth, verbal or written, documented in your record; telehealth is held to the same standard of care as in-person care. (Ark. Code Ann. §§ 17-80-402, 17-80-404).
California: You have the right to withhold or withdraw consent to telehealth at any time. All physicians practicing in California are licensed and regulated by the Medical Board of California. To verify a license or file a complaint: www.mbc.ca.gov, licensecheck@mbc.ca.gov, or (800) 633-2322. (Cal. Bus. & Prof. Code § 2290.5.) Weight-loss patients also receive the California weight-loss disclosures in the Appendix.
Colorado: Your provider may share health information as necessary for coordinated care, and you have the right to access your telehealth records. (6 Colo. Code Regs. § 1011-3).
Connecticut: Your primary care provider may obtain records from your telehealth encounter, and you may revoke consent at any time. (Conn. Gen. Stat. Ann. § 19a-906).
D.C.: You have been informed of alternate methods of communication for urgent matters, and all communications are documented in your record. (D.C. Mun. Regs. tit. 17, §§ 4618.9–4618.10).
Delaware: You have been informed of the risks, benefits, and limitations of telemedicine, including in emergencies. (24 Del. Code § 1769D).
Florida: GLP-1 weight-loss patients receive the Florida Weight-Loss Consumer Bill of Rights (see Appendix).
Georgia: You have been given clear instructions on how to obtain emergent follow-up care. (Ga. Comp. R. & Regs. 360-3-.07(7)).
Hawaii: Your provider documents your telehealth encounter as an in-person encounter, and you have the right to access those records. (Haw. Rev. Stat. § 453-1.3).
Idaho: To file a complaint: https://dopl.idaho.gov/filing-a-complaint/. Informed consent is obtained as required. (Idaho Stat. § 54-5708).
Illinois: You have the right to request an in-person evaluation, and clinically appropriate telehealth technology is used. (225 ILCS 60/49.5).
Indiana: If a prescription is issued, the prescriber notifies your primary care provider unless there is a shared EHR or an established relationship through two prior telehealth encounters. Indiana Medicaid patients may choose in-person or telehealth care. (Ind. Code Ann. § 25-1-9.5-7).
Iowa: To file a complaint with the Iowa Medical Board: ibmcomplaints@iowa.gov. Your provider identifies an in-person medical home when appropriate. (Iowa Admin. Code § 653-13.11).
Kansas: If you have a primary care provider, your telehealth provider sends a report of treatment within three business days. (Kan. Stat. Ann. § 40-2,212).
Kentucky: To file a complaint: https://kbml.ky.gov. Upon request, your physician must share your record with your PCP and care team. (KBML Telemedicine Opinion, amended Sept. 15, 2022).
Louisiana: You have been informed of the role of any other providers present during the consultation. (46 La. Admin. Code Pt XLV, § 7511).
Maine: To file a complaint: https://www.maine.gov/md/complaint/file-complaint. (Code Me. R. tit. 02-373 Ch. 11, § 3).
Maryland: Your provider maintains a complete record of your telehealth consultation and provides a copy on request. (Md. Code Ann., Health Occ. § 14-302.1).
Massachusetts: Your provider obtains informed consent and documents the encounter consistent with in-person requirements; you have the right to access your records. (243 CMR 2.16).
Michigan: Your provider documents the telehealth encounter, and you have the right to access those records. (Mich. Comp. Laws § 333.16171).
Minnesota: You have the right to receive a summary of the visit, and your provider may forward records to your PCP. (Minn. Stat. § 62A.673).
Mississippi: Your provider maintains appropriate documentation, and you have the right to access your records. (Miss. Code Ann. § 83-9-351).
Missouri: Your provider documents the encounter consistent with in-person requirements. (Mo. Code Regs. Ann. tit. 20, § 2150-4.200).
Montana: The telehealth provider is subject to the same standards of practice as in-person care, and you have the right to access your records. (Mont. Code Ann. § 37-3-102).
Nebraska: Nebraska Medicaid recipients may refuse the telehealth consultation without affecting future care or benefits, may access all resulting records, and no patient-identifiable information will be shared with researchers without written consent. (Neb. Rev. Stat. Ann. § 71-8505).
Nevada: Your provider must be licensed in Nevada and is held to the same standard of care as an in-person provider; you have the right to access your records. (Nev. Rev. Stat. § 629.515).
New Hampshire: Your provider may forward records to your primary care or treating provider. (N.H. Rev. Stat. § 329:1-d).
New Jersey: You have the right to request a copy of your medical information, which may be forwarded to your PCP; if you have none, your provider may help you identify one. (N.J. Rev. Stat. Ann. § 45:1-62).
New Mexico: Your provider maintains a record for your telehealth visit, and you have the right to access it. (N.M. Admin. Code § 16.10.5.9).
New York: GLP-1 weight-loss patients receive the New York Weight-Loss Consumer Bill of Rights (see Appendix). (N.Y. Gen. Bus. Law § 642).
North Carolina: The telehealth provider establishes a proper provider-patient relationship, and you have the right to a copy of your records upon request. (N.C. Gen. Stat. § 90-18.3).
North Dakota: Your telehealth provider is subject to the same standard of care as an in-person encounter. (N.D. Cent. Code § 23-01-46).
Ohio: Your provider may forward records to your primary care or treating provider. (Ohio Admin. Code § 4731-37-01(C)(4)).
Oklahoma: Your provider documents the encounter, and you have the right to access your records and request a copy for your PCP. (Okla. Admin. Code § 435:10-7-14).
Oregon: To file a complaint: Oregon Medical Board, 1500 SW 1st Ave., Suite 620, Portland, OR 97201-5847 · 971-673-2702 · complaintresource@omb.oregon.gov.
Pennsylvania: Your provider maintains a complete record consistent with in-person requirements, and you have the right to a copy upon request. (49 Pa. Code § 16.95).
Rhode Island: If you communicate via email or text, you have been informed about security measures and privacy risks. (Rhode Island Medical Board Guidelines).
South Carolina: Your records may be shared with other treating practitioners as permitted by law; we can help you identify a primary care medical home. SC Medicaid beneficiaries may withdraw consent at any time. (S.C. Code Ann. § 40-47-37).
South Dakota: You have received disclosures regarding delivery models and treatment limitations; your provider has discussed the diagnosis, its basis, and treatment options. (S.D. Codified Laws § 34-52-3).
Tennessee: Tennessee Medicaid recipients may request an in-person assessment prior to a telehealth assessment.
Texas: Your records may be transmitted to your PCP within 72 hours. (Tex. Occ. Code Ann. § 111.005). NOTICE CONCERNING COMPLAINTS: Texas Medical Board, Attn: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, TX 78768-2018 · 1-800-201-9353 · www.tmb.state.tx.us.
Utah: You have the right to access, supplement, and amend your PHI; contact your provider for ongoing care; obtain a copy of your record; and request transfer to another provider. (Utah Admin. Code r. 156-1-602).
Vermont: You have the right to a follow-up consultation with your distant-site provider on request. To file a complaint: http://www.healthvermont.gov. (Vt. Stat. Ann. § 9361).
Virginia: You have been informed of security measures and residual privacy risks. You agree to hold Revana Health, LLC and affiliated providers harmless for information lost due to technical failures and provide express consent to transmission of patient-identifiable information to third parties as necessary for your care. (Virginia Board of Medicine Guidance 85-12).
Washington: You have additional rights under the Washington My Health My Data Act; please review our My Health My Data Privacy Policy. You may withdraw consent to telehealth at any time. (RCW Chapter 70.372).
West Virginia: Your provider maintains a record consistent with in-person requirements, and you have the right to access and receive copies. (W. Va. Code § 30-3-13a).
Wisconsin: Your provider documents the encounter, and you have the right to access your records upon request. (Wis. Stat. § 448.9645).
Wyoming: Your telehealth provider is subject to the same standard of care as in-person encounters, and you have the right to access and receive a copy of your records. (Wyo. Stat. Ann. § 33-26-102).
Appendix: Weight-Loss Consumer Disclosures
The following disclosures apply to all patients prescribed medications for weight loss (including compounded or branded semaglutide or tirzepatide), regardless of state. Florida (Fla. Stat. § 501.0575) and New York (N.Y. Gen. Bus. Law § 642) require this notice, and we provide it to all patients as a matter of course:
- WARNING: Rapid weight loss may cause serious health problems. Rapid weight loss is defined as loss of more than 1.5 to 2 pounds per week, or more than 1 percent of body weight per week after the second week of a weight-loss program.
- Consult your physician before beginning any weight-loss program or taking any weight-loss medications.
- Long-term weight control through permanent lifestyle changes — nutritious eating and regular physical activity — is the safest and most sustainable approach.
- You have the right to ask about your provider's qualifications and training in nutrition, obesity medicine, and metabolic health.
- You have the right to ask about health risks and support components; receive an itemized list of actual or estimated costs; know the expected duration of the program; and know the identity and qualifications of any dietitian or nutritionist who reviewed the program.
California: To the extent California Civil Code §§ 1694.5–1694.9 applies, you have the right to cancel a weight-loss contract until midnight of the third business day after you sign it, and to receive a written agreement disclosing the total or estimated cost and services included. To cancel, mail or deliver written notice to Revana Health, LLC at the address in our Terms of Service.
Important Safety Information — Medications
This section provides Important Safety Information for prescription and compounded medications that may be available through affiliated providers, covering indications, contraindications, potential side effects, drug interactions, and use in special populations. It is for informational purposes only and does not replace the clinical judgment of your prescribing provider. Report adverse drug reactions to your provider, your pharmacy, and the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
GLP-1 — Compounded Semaglutide
Compounded semaglutide is not an FDA-approved drug product. FDA shortage status for branded semaglutide may affect availability of compounded versions.
BLACK BOX WARNING: Semaglutide and other GLP-1 receptor agonists are contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). In animal studies, GLP-1 receptor agonists caused thyroid C-cell tumors; the relevance to humans is unknown.
Seek immediate attention for: severe nausea/vomiting/diarrhea with dehydration; decreased urination or leg swelling; neck lump, hoarseness, or trouble swallowing; persistent severe abdominal or back pain (pancreatitis); upper abdominal pain, fever, or jaundice (gallbladder); jaundice or hepatitis signs; new or worsening vision changes; low blood sugar signs; or worsening depression or thoughts of self-harm. Do not share this medication. Do not use during pregnancy or breastfeeding; use effective contraception. Inform your provider of all medications, as semaglutide may interact with insulin and sulfonylureas and affect absorption of oral medications.
GLP-1 — Compounded Tirzepatide
Compounded tirzepatide is not an FDA-approved drug product. WARNING — THYROID TUMOR RISK: associated with thyroid C-cell tumors in animal studies. Do not use if you or a first-degree family member has a history of medullary thyroid carcinoma or MEN 2.
Seek attention for: persistent/severe abdominal discomfort (pancreatitis); kidney problems from dehydration; gallbladder disease; allergic reactions; hypoglycemia; new/worsening vision changes; or mood changes/depression. Common side effects: nausea, diarrhea, vomiting, constipation, abdominal pain, indigestion, injection-site reactions, fatigue, belching, hair loss, heartburn. Increased hypoglycemia risk with insulin/sulfonylureas; may reduce oral contraceptive effectiveness. Do not use during pregnancy or breastfeeding.
Branded Semaglutide (Wegovy®, Ozempic®) & Tirzepatide (Zepbound™, Mounjaro®)
All semaglutide-containing products carry the same class BLACK BOX WARNING as compounded semaglutide. Branded tirzepatide is indicated for chronic weight management (BMI ≥30, or ≥27 with a weight-related comorbidity) and type 2 diabetes, and carries the same thyroid tumor warning as compounded tirzepatide. Do not use with diabetic ketoacidosis, type 1 diabetes, clinically significant diabetic retinopathy, personal/family history of MEN 2 or MTC, active pancreatitis, or kidney disease requiring dialysis. Use supplemental contraception for four weeks after initiation and after each dose increase.
Testosterone (Men) — HRT
Intended for adult males with clinically diagnosed hypogonadism or testosterone deficiency; applies to FDA-approved and compounded preparations.
Serious warnings: polycythemia (elevated red blood cell count) increasing clot/stroke/heart-attack risk (hematocrit monitoring required); possible increased cardiovascular risk; may worsen or cause sleep apnea; increased risk of DVT and pulmonary embolism; may stimulate existing prostate cancer (PSA monitoring required — do not use with known or suspected prostate cancer); suppression of natural testosterone and sperm production, possibly causing infertility (discuss fertility preservation before starting); and transfer risk from gels/creams to children. Regular blood tests for testosterone, hematocrit, PSA, and liver function are required throughout treatment.
Estradiol & Progesterone (Women) — HRT
Applies to FDA-approved and compounded preparations. Risks of systemic HRT include cardiovascular disease (stroke, clots, heart attack, particularly in older women or those with risk factors); a modest increase in breast cancer risk with long-term combined therapy; increased endometrial cancer risk when estrogen is used without progestogen in women with a uterus; and higher thrombotic risk with oral versus transdermal estrogen. Report any unexpected vaginal bleeding immediately. Contraindicated with estrogen-dependent cancers, active/recent DVT/PE/stroke/heart attack, pregnancy, or undiagnosed abnormal genital bleeding. Regular follow-up including breast exams, mammography, blood pressure, and gynecological evaluation is recommended.
Peptide Therapies (BPC-157, Thymosin α-1, TB-500, Sermorelin, GHK-Cu)
Peptide therapies are compounded preparations that have not been reviewed or approved by the FDA and are prescribed at the independent clinical discretion of your provider for off-label or wellness applications. Reported side effects across peptides include injection-site reactions, nausea, dizziness, and fatigue; long-term human safety data is limited. Patients with a history of cancer should consult their oncologist before use of BPC-157, TB-500, or GHK-Cu due to potential pro-angiogenic effects. Do not use during pregnancy or breastfeeding. Sermorelin (a GHRH analogue) may interact with glucocorticoids and thyroid medications. GHK-Cu should be used with caution in copper metabolism disorders (e.g., Wilson's disease).
NAD+, IV Micronutrient & MIC/Lipo-B
NAD+ and IV micronutrient/lipotropic therapies are not FDA-approved drug products for any indication and are provided as compounded preparations under provider supervision. Common effects (particularly with IV administration): flushing, nausea or cramping, transient chest tightness or pressure (resolves with slower infusion), muscle cramping, fatigue, and injection/infusion-site reactions. Use with caution with a history of cancer, autoimmune, cardiovascular, or hepatic disease; safety in pregnancy/breastfeeding is not established. Patients with kidney disease, heart failure, or fluid-retention conditions should consult their PCP before IV fluid-based therapies. Disclose all medications and supplements to your provider.
Glutathione
A naturally occurring antioxidant tripeptide used off-label in compounded IV, IM, SC, and intranasal formulations; not FDA-approved for these indications. Common effects: injection-site reactions; with IV, transient flushing/warmth/tingling; intranasal forms may cause mild nasal irritation or altered smell. Rare allergic reactions require immediate attention. Use with caution in asthma (rare bronchospasm with nebulized forms). Safety in pregnancy/breastfeeding not established; high-dose antioxidant therapy may theoretically interact with certain chemotherapy agents.
Methylene Blue
Used off-label in compounded oral and low-dose IV formulations; at prescription doses it is a potent MAO inhibitor. SERIOUS WARNING — Serotonin Syndrome Risk: do NOT use with SSRIs, SNRIs, MAOIs, tricyclic antidepressants, tramadol, triptans, linezolid, or St. John's Wort. Symptoms (agitation, confusion, rapid heart rate, high blood pressure, muscle twitching, fever) require emergency care. Expected harmless effect: blue/green urine and stool at low doses. Contraindicated with G6PD deficiency (hemolytic anemia risk), serotonergic medications, and pregnancy/breastfeeding; use caution in renal impairment.
Finasteride (Hair Loss)
FDA-approved for male-pattern hair loss in adult men; not for women or children. Pregnant women should not handle crushed or broken tablets (Category X). Common side effects: decreased libido, erectile dysfunction, decreased ejaculatory volume, breast tenderness/enlargement. Some patients report persistent effects after discontinuation (post-finasteride syndrome). Report any mood changes or suicidal ideation immediately.
PDE5 Inhibitors — Vardenafil & Tadalafil (ED)
Common effects: headache, flushing, nasal congestion, indigestion, back/muscle aches, visual disturbances. Seek immediate attention for: severe hypotension (especially with nitrates), cardiovascular events, priapism (erection lasting over four hours — a medical emergency), sudden hearing loss, or sudden vision loss (NAION). Do not use with nitrate medications or other PDE5 inhibitors; use caution with severe cardiovascular disease, recent stroke or heart attack, or resting hypotension.
Phentermine (Schedule IV Controlled Substance)
FDA-approved as a short-term adjunct to diet and exercise for obesity (BMI ≥30, or ≥27 with a comorbidity); a sympathomimetic amine with amphetamine-like activity, prescribed only where authorized. Serious warnings: increases heart rate and blood pressure (do not use with cardiovascular disease, arrhythmia, stroke history, or uncontrolled hypertension); rare pulmonary hypertension and valvular heart disease; abuse/dependence potential (Schedule IV; short-term use, typically up to 12 weeks). Contraindicated with hyperthyroidism, glaucoma, drug abuse history, MAOIs (hypertensive crisis risk), pregnancy/breastfeeding, and agitated states.
Low Dose Naltrexone (LDN)
Naltrexone at doses below the FDA-approved range (typically 1.5–4.5 mg), used off-label in compounded formulations; not FDA-approved for these indications. Common effects: vivid dreams/sleep disturbances (especially first 2–4 weeks), nausea, headache, transient fatigue. CRITICAL WARNING: naltrexone is an opioid antagonist and can precipitate acute opioid withdrawal. Do NOT use if currently taking any opioid medication (including buprenorphine or methadone) or if you have taken opioids within the past 7–10 days. Use caution with liver disease; safety in pregnancy/breastfeeding not established.
General Disclaimers
Revana Health, LLC is a managed services organization (MSO) that provides clinical infrastructure and care coordination services. It does not practice medicine, provide medical advice, or dispense medications. All prescribing decisions are made exclusively by independent, licensed healthcare providers. Prescription medications are only available following a completed telehealth consultation and a clinical determination of appropriateness. Some treatments may involve compounded medications prepared by licensed, USA-based compounding pharmacies. Compounded medications have not been reviewed or approved by the FDA for safety, effectiveness, or quality.
Adverse Event Reporting and Contact
To report a suspected adverse reaction: FDA MedWatch at 1-800-FDA-1088 or www.fda.gov/medwatch; your prescribing provider through the patient portal; or your dispensing pharmacy. Revana Health, LLC · 3230 Southgate Circle, Suite 77, Sarasota, Florida 34239 · support@myrevana.com.