Carlo Pepia ACNP-BC · Fitness Fuel Wellness
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Telehealth
Informed Consent

Fitness Fuel Wellness · Carlo Pepia, ACNP-BC · Effective: 2026 · New York State

Note: This document is provided as a good-faith informed consent disclosure. Carlo Pepia recommends that patients read this document carefully before booking. Final form language has been reviewed for compliance with New York State telehealth law and applicable federal regulations. Questions? Contact the practice.

What Is Telehealth?

Telehealth refers to the delivery of health care services using interactive audio-video technology that permits real-time communication between the patient and the healthcare provider. At Fitness Fuel Wellness, all consultations are conducted via secure, HIPAA-compliant video platforms.

Telehealth is not a substitute for in-person care in all circumstances. Carlo Pepia will determine whether telehealth is clinically appropriate for your situation at the time of your consultation.

How Your Session Works

Your consultation will take place over a secure video call, typically 30 minutes in duration. You will receive a link via email after booking. You are responsible for ensuring you have a reliable internet connection, a compatible device, and a private location for your appointment.

  • All appointments are online — no in-person office visit is required or available
  • Sessions are conducted via a HIPAA-compliant video platform
  • You should have your bloodwork available to share during the call
  • New York State residents only — you must be physically located in New York State at the time of your appointment

Risks and Limitations of Telehealth

Telehealth services offer convenience and accessibility, but there are inherent limitations you should understand:

  • Technology failure: Dropped connections, audio or video issues, or platform outages may interrupt or prevent your session. If this occurs, Carlo will attempt to reconnect or contact you by phone.
  • Privacy risks: Although HIPAA-compliant platforms are used, no digital communication is completely without risk. You are responsible for ensuring your environment is private during the session.
  • Clinical limitations: A physical examination cannot be performed via telehealth. Carlo's assessment is based on your reported history, symptoms, and provided lab results. He may determine that in-person evaluation is necessary before certain treatments can be prescribed.
  • Not for emergencies: Telehealth is not appropriate for medical emergencies. If you are experiencing a medical emergency, call 911 or go to your nearest emergency room immediately.

Your Right to Refuse or Withdraw

Participation in telehealth services is entirely voluntary. You have the right to:

  • Refuse telehealth services and request an alternative form of care (note: Fitness Fuel Wellness does not offer in-person consultations)
  • Withdraw your consent at any time, which will end the telehealth relationship going forward
  • Ask questions about the telehealth process before or during your consultation

Withdrawing consent does not affect any care you have already received.

Emergency Procedures

Before your appointment, please have the address of the nearest emergency room or urgent care facility available. If you experience a medical emergency during your session, Carlo will direct you to call 911 immediately. Fitness Fuel Wellness is not equipped to dispatch emergency services on your behalf.

Privacy and Confidentiality

Your health information is protected under the Health Insurance Portability and Accountability Act (HIPAA). Please review our HIPAA Notice of Privacy Practices for full details on how your information is used, stored, and protected.

Sessions are not recorded without your explicit written consent. You are also prohibited from recording sessions without Carlo's consent.

Treatment-Specific Consents

In addition to this general telehealth consent, patients receiving the following services will be asked to sign additional treatment-specific consent forms as part of the intake process:

  • Hormone Therapy / TRT: Consent covering cardiovascular risks, fertility effects, monitoring requirements, and the controlled substance status of testosterone (Schedule III)
  • Compounded Peptide Therapy: Consent acknowledging the compounded, non-FDA-approved nature of peptide medications, off-label use, and sourcing from licensed 503B compounding facilities
  • Compounded Medications (general): Acknowledgment that compounded drugs are not FDA-approved and carry different quality standards than commercially manufactured medications

These forms will be sent to you via the Optimantra patient portal immediately after booking. Your appointment will not be confirmed until all required forms are completed.

Provider Credentials

Carlo Pepia, ACNP-BC is a board-certified Acute Care Nurse Practitioner, currently practicing at NYU Medical Center and licensed in New York State. He is authorized to provide telehealth services and prescribe medications within his scope of practice under New York State law.

Questions or Complaints

If you have questions about this consent or the telehealth process, contact the practice before your appointment at the contact page. If you believe your privacy rights have been violated, you may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/hipaa/filing-a-complaint.

By booking an appointment with Fitness Fuel Wellness, you acknowledge that you have read, understood, and consent to the terms of this Telehealth Informed Consent. You confirm that you are physically located in New York State and are 18 years of age or older.

Consent is documented at the time of booking and stored in your patient record per New York State telehealth documentation requirements.

© 2026 Fitness Fuel Wellness · Carlo Pepia, ACNP-BC · New York State

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