Need fast aesthetic or wellness care? Same-day consults may be available — book with our NP-led team.

#1 Best Med Spa in Oswego·We screen you like a medical practice, because we are one.(630) 636-6193

HG

We screen you like a medical practice, because we are one.

Hello Gorgeous
Medical Aesthetics & Wellness
Confidential DocumentLast updated: February 4, 2026
Patient Copy — Please retain for your records
If you are experiencing a life-threatening emergency, call 911 immediately. For mental health crises, call or text 988 — the Suicide & Crisis Lifeline is available 24/7.
Authorization to Use & Disclose Medical Information
Consent to Telehealth  ·  Open Payments Notice
This consent form provides information about telehealth services and obtains your informed consent to receive healthcare and/or mental health services from licensed providers through Hello Gorgeous Med Spa's digital platform. By clicking "I Agree" below, you acknowledge you have read and accepted all terms. If you do not agree, do not create an account or use the service.
01   Purpose
What is telehealth?
Telehealth involves the delivery of healthcare and mental health services using electronic communications, information technology, or other means between a provider and a patient who are not in the same physical location. Services may include diagnosis, treatment, follow-up visits, and patient education — delivered through secure messaging, audio, video, and data communications.

Alternative in-person methods of care may be available to you. You may choose an in-person alternative at any time by discussing options with your provider.
02   Benefits
What telehealth offers you
  • Convenient access to licensed medical and aesthetic providers without requiring an in-person visit
  • Flexible scheduling at times that work for your lifestyle
  • Reduced stress and travel burden associated with in-clinic appointments
  • For mental health services: potential reduction in anxiety, improved relationships, and progress toward your wellness goals
03   Risks
Potential limitations to be aware of
No service is without limitation. Before consenting, please review the following:
Technology limitationsPlatform errors, connectivity issues, or bugs may limit functionality or affect the accuracy of records and results.
Diagnostic constraintsInability to perform in-person physical examinations may prevent diagnosis in some cases or delay identification of urgent needs.
Data privacyElectronic communications, including email, carry inherent security risks. While we use robust encryption, we cannot guarantee your email provider's security.
Prescription limitationsRegulatory requirements in certain jurisdictions may limit diagnosis and treatment options, particularly certain prescriptions.
Incomplete recordsA provider's lack of access to your full medical history may result in potential adverse drug interactions or other clinical errors.
Mental health servicesIt is normal and sometimes expected to feel worse before you feel better during therapy. Your provider will monitor your progress.
04   Emergency Protocol
When telehealth is not appropriate
If your situation is an emergency, call 911. Telehealth is not a substitute for emergency care. Your provider may not respond immediately to messages submitted through the platform. If you require urgent care, please visit an emergency room or urgent care facility.

If a technical failure prevents you from reaching your provider through our platform, call us directly at (630) 636-6193 — Hello Gorgeous Med Spa.
05   Privacy & Data
How we protect your information
Our platform uses industry-standard network and software security protocols to protect your personal and protected health information (PHI). Your information will not be disclosed to any third party without your consent, except as authorized by law — including consultation, treatment, billing, mandatory reporting requirements (such as danger to self or others, or abuse reporting), or as set forth in your provider's Notice of Privacy Practices.
06   Laboratory Services
If lab testing is part of your care
Certain services may include laboratory testing. If applicable, your provider may order tests using an at-home kit or a local blood collection site. Lab tests carry standard risks including discomfort, bruising, or, rarely, infection at the draw site.
Important: Laboratory tests are processed by affiliated or third-party labs. Neither Hello Gorgeous Med Spa nor your provider can guarantee the accuracy of results. Testing may produce false positives, false negatives, or inconclusive results. By agreeing to testing, you exercise your right of direct access to results under federal law and waive any standard delay period. You are responsible for sharing results with your primary care physician and pursuing follow-up care.
07   Open Payments
Federal disclosure notice
The federal Physician Payments Sunshine Act requires that payments of value over $10 from drug and device manufacturers to physicians and teaching hospitals be made publicly available. You may search this database at openpaymentsdata.cms.gov.
08   Your Acknowledgments
By signing below, you confirm that you understand and agree:
  • Healthcare services will be delivered via telehealth by licensed physicians, nurse practitioners, physician assistants, and/or mental health professionals.
  • Technology used to deliver care may be in beta phases and may contain errors that could affect care quality.
  • No specific results, benefits, or cures can be guaranteed through telehealth or associated laboratory testing.
  • Your condition may not improve, and in some cases may worsen — in which case you will be referred to appropriate in-person care.
  • You may withdraw consent in writing at any time without penalty, though this will affect your ability to use the platform, as our providers do not offer in-person treatment.
  • You will provide truthful, accurate, and complete information — including current medications, medical history, and emergency contacts.
  • You understand that online sessions will not be recorded by you or your provider.
  • Hello Gorgeous Med Spa has commercial relationships with pharmacy and laboratory partners; you may obtain prescriptions from a pharmacy of your choice by contacting our support team.
  • You are responsible for all costs associated with your care and will not submit claims to Medicare or other federal payors.
Commercial relationships

Hello Gorgeous Med Spa has a financial relationship with the entity that employs or contracts with your provider, and commercial relationships with BPI Labs LLC, EHT Pharmacy LLC dba Curexa, XeCare LLC, Apostrophe Pharmacy LLC, Strive Specialties Inc., CD Pharmacy LLC (d/b/a Red Rock Pharmacy), AnazaoHealth Corporation, H&H Labs LLC, Quest Diagnostics Incorporated, and Grail, Inc. You are free to receive examination from any provider not associated with our platform.
Patient Signature & Confirmation
Your signature
Sign here with your mouse or finger
State-specific notices

California patients: Physicians and midwives are licensed and regulated by the Medical Board of California. To confirm a license or file a complaint, visit mbc.ca.gov or call (800) 633-2322. The California Board of Behavioral Sciences handles complaints about licensed counselors, social workers, and therapists — reach them at bbs.ca.gov or (916) 574-7830.

For concerns about a provider in any state, contact your state's Medical Board. If you have questions about this consent, reach our patient services team at any time.
Hello Gorgeous
© 2026 Hello Gorgeous Med Spa  ·  All rights reserved  ·  Confidential patient document