Hot Tub Prescription LLC
Last Updated: July, 17 2026
Statement of Accuracy, Responsibility, Consent & Records Authorization
In this statement, “Company” means LotaRx, LLC d/b/a Hot Tub Prescription, and “provider” means the independent licensed healthcare professional who reviews my request.
By submitting this request, I affirm that all information I have provided is accurate, truthful, and complete to the best of my knowledge. I understand this is an online, asynchronous (store-and-forward) telehealth documentation review to determine whether provider documentation may be clinically appropriate for a documented health condition.
I understand:
• This is a telehealth review and documentation service only. It is not primary care, emergency care, or ongoing treatment, and it does not create an ongoing provider–patient relationship beyond this review. If I am experiencing a medical emergency, I will call 911.
• This is not tax, legal, financial, insurance, reimbursement, or benefits advice.
• Submitting this application does not guarantee approval or issuance of documentation. The provider retains full clinical discretion to approve or deny any request, and all determinations are based solely on the information I provide.
• I must personally complete and submit this form. It may not be completed by a retailer,
salesperson, or any other third party on my behalf.
• This service is intended only for individuals with a documented health condition. It is not for leisure, recreational, or general wellness use.
• This service is not a substitute for in-person medical care. I will consult my own physician if my condition changes or before beginning any new therapy.
Retroactive prescriptions are not permitted:
Prescriptions and Letters of Medical Necessity are signed and dated on the day they are reviewed. They will not be backdated under any circumstance. It is my responsibility to obtain the proper documentation before purchasing a potentially qualifying device. Documentation must be dated prior to the purchase of the device. If a device has already been purchased or delivered, it may not qualify for an exemption or other benefit.
Sharing of records with my retailer:
If documentation is issued, I authorize the Company and its affiliated providers to share the issued prescription and/or Letter of Medical Necessity — together with my name and the basic order details needed to match the paperwork to my purchase — with the retailer I identify in this form or from whom I purchase my device, solely so that the retailer can prepare and submit tax-exemption or other required paperwork connected to my purchase.
My questionnaire responses, medical history, and any records or documents I upload will not be shared with my retailer. Only the issued prescription and/or Letter of Medical Necessity, and matching order details, are shared. I understand this authorization is voluntary, that my retailer is an independent business and not a healthcare provider, and that information may no longer be protected by health-privacy laws once the retailer receives it. I may revoke this authorization for future disclosures at any time by emailing
info@hottubprescription.com. Unless revoked earlier, it expires one (1) year from the date of my consent of these terms or upon completion of the related paperwork, whichever comes first.
Additional terms:
• I am at least 18 years old and am completing this request for myself.
• I agree that my electronic signature and selections on this form are legally binding, the same as a handwritten signature.
• I agree to indemnify and hold harmless the Company and its affiliated providers from claims, losses, or penalties arising from inaccurate or incomplete information I provide, or from my use or submission of the issued documentation.
• My records are maintained in accordance with applicable law and the Company’s Privacy Policy.
By continuing, I acknowledge:
• I understand this is a telehealth review and documentation service only.
• I understand the provider’s role is limited to reviewing my submitted materials and, if clinically appropriate, issuing documentation based solely on professional clinical judgment.
• I accept full responsibility for the accuracy of my submission and for any use of the documentation provided.
• No retailer, salesperson, or other third party has completed this form for me, told me what medical information to provide, or promised me that documentation will be issued.
• No tax savings, deductions, exemptions, reimbursements, approvals, benefits, or financial outcomes are promised, implied, or guaranteed.
• I understand that any tax, financial, reimbursement, benefits, or approval outcome is outside the control of the Company and the provider and depends on my state, my retailer, and the applicable authority.