1. Eligibility & Safety

• I am not pregnant or breastfeeding.
• I am 18 years or older.
• I have no known allergy to Ivermectin.
• I do not have severe asthma or severe liver disease.
• I do not have hyperactive onchodermatitis, concurrent loiasis, or onchocerciasis; and I understand Ivermectin can worsen bronchial asthma.

2. Treatment Purpose & Use

• I am requesting Ivermectin for the treatment or management of suspected or confirmed parasitic infections.
• I understand Ivermectin is FDA-approved for certain parasites, and may be used off-label for other parasites or conditions at the discretion of a licensed provider.

3. Drug Interactions

• I will accurately disclose all medications and supplements I take.
• I understand Ivermectin may interact with: Warfarin (Coumadin/Jantoven), Sirolimus (Rapamune), Tacrolimus (Advagraf XL/Envarsus XR), Erdafitinib (Balversa), Lasmiditan (Reyvow), Tepotinib (Tepmetko), Erythromycin (all forms), Itraconazole, Ketoconazole, Rifampin (Rifadin), and Verapamil.
• If taking Warfarin or other anticoagulants: I understand INR may increase and bleeding risk may rise; I agree to monitor INR and consult my provider as needed.

4. Monitoring & Side Effects

• I agree to seek immediate medical attention if I experience severe or unexpected symptoms while using Ivermectin.
• I have reviewed the medication guide: medlineplus.gov/druginfo/meds/a607069.html.
• Potential side effects include dizziness, skin itching, nausea, diarrhea, joint pain, or low blood pressure.

5. How the Medication is Provided

• I understand the Ivermectin provided may be custom-compounded using USP-grade ingredients by a licensed pharmacy.
• The dose may be based on body weight and my clinical needs as determined by the provider.

6. 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 or State ID or Passport (or photo of any government-issued ID) ready on this device to upload.

7. Consent, Risks & Liability

• I give my full consent for RightMD Inc. and its affiliated medical/pharmacy teams to evaluate, prescribe, and dispense Ivermectin for parasite treatment based on the information I provide.
• I accept the risks associated with this therapy and understand outcomes are not guaranteed. To the extent permitted by law, RightMD Inc., its providers, pharmacies, and staff are not liable for adverse outcomes arising from my failure to disclose information, non-adherence, or misuse of the medication.

8. Payments & Refund Policy

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

9. Policies

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