Empathra Medical P.C., provided through the Mica Peak Health platform. Effective / last updated: June 20, 2026
Please read before you begin care. This consent explains your telehealth care, the medications that may be involved, and your responsibilities. You will be asked to confirm your agreement at the end of intake. If you do not agree, you should not proceed and will not be treated.
01
Who provides your care
Your medical care is provided by licensed clinicians of Empathra Medical P.C. (“Empathra,” “we,” “us”), an independent professional medical entity. Empathra delivers care through the technology platform operated by Mica Health Ventures, LLC (d/b/a Mica Peak Health) (“Mica Peak”). Mica Peak is a technology and administrative company; it does not provide medical care, does not employ your clinician, and does not dispense medication. By proceeding, you are establishing a patient relationship with Empathra and its clinicians.
02
Consent to telehealth
Telehealth is the delivery of health care using secure electronic communications. Depending on your state, your service, and your clinician's judgment, your care may be delivered by live video or telephone (synchronous) or by your clinician's secure review of the information and questionnaires you submit, without a live visit (asynchronous or “store-and-forward”), where permitted by law. You consent to receive care by these methods.
Benefits and limitations. Telehealth can improve access and convenience. It also has limits: your clinician generally cannot perform a hands-on physical examination, technology can fail or be interrupted, and the information available may be incomplete. Your clinician may decide that telehealth is not appropriate for you and may require in-person care, laboratory testing, or additional information before treating you.
Privacy and records. Reasonable measures are used to protect your information, but no electronic communication is completely secure. A record of your telehealth care is maintained. Your information is handled as described in Empathra's Notice of Privacy Practices under HIPAA.
Not for emergencies. Telehealth through this platform is not for medical emergencies. If you are experiencing an emergency, call 911 or go to the nearest emergency room.
Your choices. Participation is voluntary. You may withhold or withdraw your consent to telehealth at any time without affecting your right to future care or treatment, though doing so may end your ability to receive care through this platform.
03
Consent to evaluation and treatment
You consent to evaluation, diagnosis, and treatment by Empathra's clinicians, which may include reviewing your history, ordering laboratory tests, prescribing medications, and recommending follow-up. You understand that whether you are treated, and what is recommended or prescribed, is determined solely by your clinician's professional judgment, and that submitting information or paying a fee does not guarantee any prescription or particular treatment. You understand that the practice of medicine is not an exact science and that no specific outcome or result has been or can be guaranteed.
04
Controlled substances: testosterone therapy
Some treatment, including testosterone therapy, involves controlled substances. Testosterone is a Schedule III controlled substance. You acknowledge and agree to the following:
- You will use any prescribed controlled substance only as directed, only for yourself, and will not share, sell, or divert it.
- You consent to checks of your state's prescription-drug-monitoring program (PDMP), to identity verification, and to use of a single designated pharmacy.
- You will disclose all other medications, prescribers, and relevant history, and will not seek the same or similar controlled substances from other providers at the same time.
- You understand that prescribing controlled substances by telemedicine is governed by federal (including the Ryan Haight Act and DEA rules) and state law, and that your clinician may require an in-person evaluation, laboratory testing, or a referral, or may decline or discontinue prescribing, based on those rules and clinical judgment.
Risks of testosterone therapy. You understand testosterone therapy carries risks, which your clinician will discuss with you, and which may include reduced fertility or sperm production, increased red-blood-cell count (polycythemia), acne or skin reactions, changes in mood, effects on the prostate, fluid retention, and possible cardiovascular effects. Ongoing monitoring and laboratory testing are part of safe treatment, and you agree to complete recommended monitoring.
05
Compounded medications
Some treatment, including certain weight-management (GLP-1) and hormone therapies, may involve compounded medications prepared by a licensed compounding pharmacy for an individual patient.
Compounded medications are not FDA-approved and are prescribed only when a licensed clinician determines a compounded formulation is appropriate for an individual patient.
What this means. Compounded medications are not reviewed or approved by the FDA for safety, effectiveness, or manufacturing quality. Compounded semaglutide and tirzepatide are not the same as, and are not therapeutically equivalent to, FDA-approved branded products (such as Ozempic, Wegovy, Mounjaro, and Zepbound), which are available and which your clinician can discuss with you. A compounded medication is used only when your clinician determines it is clinically appropriate for you as an individual and is permitted under applicable law.
Safe use. Because compounded injectables can differ in concentration and presentation from branded products, dosing errors are possible. You agree to follow your clinician's and the pharmacy's instructions exactly, not to change your dose on your own, to ask questions if anything is unclear, and to report side effects to your clinician, and to seek emergency care for any emergency.
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Your responsibilities
To receive safe care, you agree to: provide accurate and complete information about your identity, location, and health; be physically located in a state where Empathra is licensed at the time of your visit; keep your contact and payment information current; follow your treatment plan and complete recommended labs and follow-up; and promptly report side effects or concerns. Providing false information or misusing medication may result in discontinuation of care and may be reported as required by law.
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Financial responsibility
Care through Empathra is provided on a cash-pay basis. We do not bill or submit claims to health insurance, Medicare, or Medicaid. You are responsible for the membership and any consultation fees, which are processed through the Mica Peak platform, and for the separate cost of any medications. You authorize Mica Peak, on Empathra's behalf, to charge your payment method for the fees you incur. The Mica Peak Terms of Service describe pricing, automatic renewal, cancellation, and refunds.
08
Authorization and privacy
You authorize Empathra and its clinicians to use the Mica Peak platform to deliver your care and to share your information with pharmacies, laboratories, and service providers as needed to provide and coordinate your treatment. Your protected health information is used and protected in accordance with HIPAA and Empathra's Notice of Privacy Practices. Information collected by the platform is also described in Mica Peak's Privacy Policy and Consumer Health Data Privacy Policy.
09
Acknowledgment and consent
By checking the box at intake and proceeding, you confirm that:
– You are at least 18 years old and are using the services for yourself.
– You have read and understand this Telehealth Informed Consent & Consent to Treatment.
– You have had the opportunity to ask questions and consent to receive care by telehealth, including, where applicable, treatment with controlled substances and compounded medications.
– The information you have provided is true and complete to the best of your knowledge.
You provide this consent electronically by checking the consent box during sign-up. Checking that box, which links to this document, has the same effect as a signature. The date and time of your acceptance are recorded, and a copy of this consent is available to you at any time in the patient portal.
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Contact
Empathra Medical P.C. · care provided through the Mica Peak Health platform.
Questions about your care: through the patient portal. Platform, billing, and account support: support@micapeakhealth.com.