Telemedicine Consultation — In accordance with Telemedicine Practice Guidelines 2020, MCI
Important: Please read this consent form carefully before proceeding. By submitting your health profile, you confirm that you have read, understood, and agreed to all items below.
About this consent
FitScript operates as a telemedicine platform connecting patients with NMC-registered doctors for GLP-1 weight loss consultations. Under the Telemedicine Practice Guidelines 2020 issued by the Board of Governors, Medical Council of India, patient consent must be obtained before any telemedicine consultation.
This form covers your consent to: the telemedicine consultation, the use of your medical information, the prescription process, and the receipt of medication.
Consent checklist
Telemedicine consultationI understand that my consultation with a FitScript doctor will take place via video call (telemedicine) and not as an in-person visit. I understand that telemedicine has limitations compared to a face-to-face consultation.
Accuracy of medical informationI confirm that all medical information I have provided in my health profile is accurate, complete and up to date. I understand that withholding or misrepresenting medical information may affect the safety of my prescription.
No guarantee of prescriptionI understand that submitting my health profile and paying the consultation fee does not guarantee a prescription will be issued. The prescribing doctor will assess my clinical suitability independently and their decision is final.
GLP-1 medication risks and side effectsI have been informed that GLP-1 receptor agonists may cause side effects including nausea, vomiting, diarrhoea, fatigue, and in rare cases pancreatitis or thyroid changes. I will discuss these risks fully with my doctor during the consultation.
Contraindications declarationI confirm that I am not pregnant, breastfeeding, or planning to become pregnant within the next 2 months. I understand that GLP-1 medications are contraindicated in these cases.
Data sharing and privacyI consent to my personal and medical information being shared with my assigned NMC-licensed FitScript doctor and with licensed pharmacies for dispensing purposes. I have read and understood the Privacy Policy.
Right to withdrawI understand I can withdraw my consent at any time before the consultation takes place by contacting FitScript support. Withdrawal after the consultation has commenced may not be possible.
Patient declaration
Please provide your name and today's date to confirm your consent.
By clicking above you are providing your informed consent as required under the Telemedicine Practice Guidelines 2020, Ministry of Health and Family Welfare, India.
Consent recorded ✓
Thank you. You will now be redirected to your health profile form.