1. Eligibility & Safety

• I am not allergic to Ivermectin. If I have any allergy, I will list it during intake.
• I am not pregnant or breastfeeding at this time.
• I do not have Severe Asthma, Severe Liver Disease, hyperactive Onchodermatitis, Concurrent Loiasis, or Onchocerciasis (and I understand Ivermectin may worsen bronchial asthma).

2. Medical History & Screening

• I will disclose any known drug allergies.
• I will indicate whether I have taken Ivermectin before and, if yes, provide dose, duration, and reason.
• I will choose at least one reason for requesting Ivermectin 3 mg (Covid Treatment Support; Long Covid; Covid Prevention; Cancer Wellness; Parasite Cleanse) and describe my current symptoms/condition & duration.
• I will state whether I have been diagnosed by a clinician for the listed condition(s) and include the diagnosis and date if applicable.
• I will list all medications and supplements I take (include dose if known) and disclose any current or past medical conditions.
• I will enter my weight (lbs) for dosing.

3. Indications & Off-Label Use

• I understand that Ivermectin is FDA-approved for certain parasitic infections.
• I understand that other uses listed here (COVID-19 Treatment Support, Long COVID, COVID Prevention, Cancer Wellness) may be off-label and will be provided only if determined appropriate by a licensed provider.

4. Drug Interactions

• I understand Ivermectin may interact with: Warfarin (Coumadin/Jantoven), Sirolimus, Tacrolimus, Erdafitinib, Lasmiditan, Tepotinib, Erythromycin, Itraconazole, Ketoconazole, Rifampin, and Verapamil. I agree to accurately disclose my medications and follow medical guidance.
• If taking Warfarin or other anticoagulants: I understand Ivermectin may increase INR and raise bleeding risk. I agree to monitor INR and consult my provider if needed.

5. Monitoring & Side Effects

• I agree to seek immediate medical attention and notify the provider if I experience severe side effects or if my condition worsens.
• I have reviewed the medication guide: medlineplus.gov/druginfo/meds/a607069.html.
• Potential side effects may include nausea, dizziness, itching, diarrhea, muscle/joint pain, or low blood pressure.

6. How the Medication is Provided

• Tablets may be dispensed as manufactured product or custom-compounded using USP-grade active ingredients by a licensed pharmacy.
• Dosing will be based on my weight and clinical profile at the provider’s discretion.

7. Identification & Confidentiality

• Uploading a valid government-issued photo ID is a legal requirement to verify my identity before the consultation can be completed.
• This verification complies with state and federal telemedicine regulations.
• My personal information and ID will be handled securely, stored confidentially, and never shared except as required by law or to provide my medical care.

IMPORTANT: Please keep a clear image of your Driver’s License / State ID / Passport (or photo of any government-issued ID) ready on this device to upload.

8. Consent

• I give my full consent for RightMD INC and its affiliated medical/pharmacy teams to prescribe and dispense Ivermectin 3 mg tablets based on the information I have provided. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and other affiliated teams from liability related to this treatment.

9. Payments & Refund Policy

• All purchases and services are final and non-refundable.

10. Policies

• I have read and agree to the Terms & Conditions, Privacy Policy, and Refund & Cancellation Policy.