Patient Consent, Privacy, and Payment Policy

Thank you for completing the health intake form. Your information will be carefully reviewed by a licensed physician. Based on your responses, the doctor will determine if a prescription is appropriate. If more information is needed, the doctor may contact you by phone or schedule a video consultation via Google Meet.

If your prescription is approved, it will be sent directly to our partner pharmacy. Your medication will then be shipped straight to your home, typically within 7–10 business days.

If the doctor determines that a prescription cannot be issued, you will receive a full refund.

HIPAA Privacy Policy

• Your health information will be used or disclosed only for treatment, prescription evaluation, pharmacy fulfillment, payment, healthcare operations, or as otherwise required or permitted by law.
• All information you provide is kept strictly confidential and stored securely. Only authorized personnel involved in your care or processing your prescription will have access to your information.
• You have the right to request access to your health records, request corrections, and obtain an accounting of disclosures. You may request restrictions on certain uses or disclosures of your information, as permitted by law.
• We may contact you by phone, email, or secure video call (such as Google Meet) as necessary for your care and treatment.
• We use administrative, physical, and technical safeguards to protect your information against unauthorized access, loss, or misuse.
• For any questions about our privacy practices or your rights under HIPAA, please contact us at 1-866-A2ZRXUS (1-866-229-7987) or support@a2zrx.us.

Payment Information and Security

• By providing your payment card details, you authorize A2ZRX LLC to charge your card for the services described.
• All card information is processed through secure, PCI-compliant payment systems. We do not store your full card details on our servers.
• Your payment information will not be shared, sold, or disclosed to third parties except as required for transaction processing or by law.
• If your prescription is not approved by the doctor, you will receive a full refund to your original payment method.
• Charges will appear on your card statement as A2ZRX LLC.
• For questions or concerns regarding your payment or billing, please contact us at 1-866-A2ZRXUS (1-866-229-7987) or support@a2zrx.us.

Consent

By checking the box below and submitting this form, you confirm that you have read, understood, and accept the Patient Consent, HIPAA Privacy Policy, and Payment Information Security Policy above.

I accept the Patient Consent, HIPAA Privacy Policy, and Payment Information Security Policy.