Consent to Treat

I consent to receive healthcare services from Boggs Wellness, LLC. This may include evaluation, diagnosis, treatment planning, and medical management as deemed appropriate by my provider. I understand that care may involve reviewing my medical history, discussing symptoms, and considering lifestyle or medication-based treatment options.

I understand that while outcomes are not guaranteed, my provider will make every effort to offer care that is safe, evidence-informed, and tailored to my needs. I agree to provide honest, complete information and to communicate any changes in my health or medication use.

All care provided by Boggs Wellness, LLC is conducted in accordance with the scope of practice and prescriptive authority guidelines set forth by the Oklahoma Board of Nursing and the American Academy of Nurse Practitioners.

I also understand that Boggs Wellness, LLC may discontinue my care if it is determined that treatment is no longer appropriate, safe, or aligned with the practice’s philosophy or scope of services.

This consent remains valid unless withdrawn in writing.

Prescription Medication Consent

I consent to the prescription and use of medications recommended by Boggs Wellness, LLC. I understand:

• Medications may be prescribed based on clinical guidelines, my history, and provider judgment.

• Some medications may be prescribed "off-label" if supported by evidence and deemed safe and appropriate.

• All potential risks, benefits, and alternatives will be explained to me, and I may ask questions at any time.

I will follow directions as provided, report any side effects, and notify my provider of any changes in my health or medications. I may choose to stop treatment at any time.

HIPAA Consent

I acknowledge that I’ve been offered access to the HIPAA Notice of Privacy Practices from Boggs Wellness, LLC, which explains how my medical information may be used and disclosed.

I understand my information is handled with care and that my privacy is protected in accordance with state and federal law.

I understand that the HIPAA Privacy Policy is available on the main Boggs Wellness website and may be reviewed at any time. I may also request a printed or digital copy of the policy at any time.

I consent to the use of secure, HIPAA-compliant platforms to manage and communicate my health information, including secure patient messaging and encrypted email or video platforms.

I may revoke this consent in writing at any time.

Telemedicine Consent

I understand that telemedicine involves using secure audio, video, and digital tools to receive care when the provider and patient are not in the same location. I consent to receive care via telemedicine from Boggs Wellness, LLC.

I understand:

• My provider will use clinical judgment to determine whether my needs can be met virtually.

• Limitations may exist due to the lack of a physical exam, but efforts will be made to deliver safe and appropriate care.

• Telemedicine tools used are HIPAA-compliant, but no system is completely risk-free.

I may stop or withdraw consent for telemedicine at any time. All questions have been answered to my satisfaction.