Terms & Conditions
Consent form for the use of Ketamine with Oxytocin and/or Any other Controlled Substance.
The use of ANY Controlled Substance may cause addiction and is only one part of the treatment for Social Anxiety Disorder and/or Depression, PTSD, pain and Alcoholism.
My Klouds Kompound will be used as medicine to improve my overall mental health including social anxiety, depression and/or PTSD, pain and alcoholism without causing any dangerous symptoms.
I agree to use my prescribed Klouds Kompound as prescribed and will not share my medicine with any other person.
I agree to inform my provider:
+ if I have used any other controlled substances, I’ve consumed either those prescribed or otherwise
+ if I have consumed alcohol or any other cannabinoid compound while using prescribed controlled substances
+ if I have been treated for side effects or complications related to the use of controlled substances related to the use of controlled substance, including if I have experienced an overdose
+ if there is any other state that I have previously resided in and/or had a prescription for a controlled substance filled
I agree to any additional monitoring of my drug use when deemed medically necessary by my provider
I understand that my provider may change or discontinue this controlled substance treatment as he/she deems best for my health
Konsent for Treatment and Privacy Practices
I have requested medical service from Klouds Rx on behalf of myself and understand that by making this request, I become fully financially responsible for all charges incurred during the treatment authorized. I do hereby consent to necessary examination procedures and/or treatments prescribed by my physician, his assistants, or designee as is necessary in their judgement. I understand the situations in which this practice may need to utilize or release my medical records. I understand that this office will properly maintain my records and will use all due means to protect my privacy.
Financial Responsibility
All professional services rendered are charged to the patient and are due at the time of service. Any medications will be an additional charge(s) and billed on a monthly subscription basis. We accept all major credit cards for recurring monthly charges.
Cancellation Policy
We have implemented a "No Show / Cancellation" policy which enables us to better utilize available appointments for our patients. The following policy is with regards to patients who fail to keep their scheduled appointments, procedure and/or surgery. * Patients who fail to show for their scheduled appointment or did not cancel within 24 hours of their scheduled appointment time shall be subject to a "No Show / Cancellation" fee. Fee charged is the value of your scheduled appointment, this is a non-refundable fee. In the event of an actual emergency and prior notice could not be given, consideration will be given, and a one-time exception may be granted.
Email Permission Policy
I authorize Klouds Rx to add me to their newsletter for merch drops, informational blogs and content, updates and more.
SMS/MMS Mobile Message Marketing Program Terms and Conditions
Klouds Rx (hereinafter, “We,” “Us,” “Our”) is offering a mobile messaging program (the “Program”), which you agree to use and participate in, subject to these Mobile Messaging Terms and Conditions (the “Agreement”). We may modify or cancel the Program or any of its features without notice. This Agreement is limited to the Program and is not intended to modify other Terms and Conditions or Privacy Policy that may govern the relationship between you and Us in other contexts. We may also modify this Agreement at any time and your continued use of the Program following the effective date of any such changes shall constitute your acceptance of such changes.
The Program allows Users to receive SMS/MMS mobile messages by opting into the Program, such as through online or application-based subscription forms. Your consent to receive automated marketing text messages is not required as a condition of purchasing any goods or services. Regardless of the opt-in method you used to join the Program, you agree that this Agreement applies to your participation in the Program. If you have opted in, the Program provides updates, alerts, information, promotions, specials, and other marketing offers (e.g., product discounts) from Klouds Rx via text messages through your wireless provider to the mobile number you provided. SMS/MMS mobile messages may be sent using an automated telephone dialing system or other technology. Message frequency varies. You are responsible for all charges and fees associated with text messaging imposed by your wireless provider. Message and data rates may apply.
If you do not wish to continue participating in the Program or no longer agree to this Agreement, you agree to reply STOP to any mobile message from Us in order to opt-out of the Program. You may receive an additional mobile message confirming your decision to opt-out. You understand and agree that the preceding options are the only reasonable methods of opting out. You also understand and agree that any other method of opting out, including, but not limited to, texting words other than those set forth above or verbally requesting one of our employees to remove you from our list, is not a reasonable means of opting out.
For any questions please text "HELP" to the number you received the messages from. You can also contact us for more information. If you wish to opt-out please follow the procedures above.
We may change any telephone number we use to operate the Program at any time and will notify you of these changes. You acknowledge that any messages, including any STOP or HELP requests, you send to a telephone number we have changed may not be received and we will not be responsible for honoring requests made in such messages.
The wireless carriers supported by the Program are not liable for delayed or undelivered messages. You agree to provide us with a valid mobile number. You agree to maintain accurate, complete, and up-to-date information with us related to your receipt of messages, including, without limitation, notifying us immediately if you change your mobile number.
You agree to indemnify, defend, and hold us harmless from any third-party claims, liability, damages, or costs arising from your use of the Program or from you providing us with a phone number that is not your own. If at any time you intend to stop using the mobile telephone number that has been used to subscribe to the Program, including canceling your service plan or selling or transferring the phone number to another party, you agree that you will complete the Opt-Out process set forth above prior to ending your use of the mobile telephone number. You understand and agree that your agreement to do so is a required part of these terms and conditions. You further agree that, if you change your telephone number without notifying Us of such change, you agree that you will be responsible for all costs (including attorneys’ fees) and liabilities incurred by Us, or any party that assists in the delivery of the SMS/MMS mobile messages, as a result of claims brought by individual(s) who are later assigned that mobile telephone number. This duty and agreement shall survive any cancellation or termination of your agreement to participate in any of our Programs.
You agree that we will not be liable for failed, delayed, or misdirected delivery of any information sent through the Program, any errors in such information, and/or any action you may or may not take in reliance on the information or Service.
You may not use or engage with the Platform if you are under thirteen (13) years of age. If you use or engage with the Platform and are between the ages of thirteen (13) and eighteen (18) years of age, you must have your parent’s or legal guardian’s permission to do so. By using or engaging with the Platform, you acknowledge and agree that you are not under the age of thirteen (13) years, are between the ages of thirteen (13) and eighteen (18), and have your parent’s or legal guardian’s permission to use or engage with the Platform, or are of adult age in your jurisdiction. By using or engaging with the Platform, you also acknowledge and agree that you are permitted by your jurisdiction’s Applicable Law to use and/or engage with the Platform.