Published clinical standards

The rules we practise by,

You should not have to take an online clinic on trust. Here are our protocols. Every clinical rule below is written into the intake software, and published here so you can hold us to it.

These are the standards olo launches with. Items marked ◇ are commitments for launch and are not yet live.

Last updated 28 August 2026

01 / 06

Identity, verified properly

◇ Ontario health card validated against the province’s Health Card Validation (HCV) service
◇ Government photo ID matched to a live selfie
◇ Physical presence in Ontario confirmed at every consultation
◇ A second identity check by the dispensing pharmacy at first fill

02 / 06

One physician, accountable

Every chart is reviewed personally by a CPSO-licensed Ontario family physician
Where possible, the same physician follows your care across visits and refills
No prescription is ever generated by software — protocols screen, humans decide
◇ Every decision, refusal, and referral is written to a permanent audit log

03 / 06

Tiered laboratory gating

Green — no labs required for the treatment
◇ Yellow — labs recommended; declining requires a signed informed-refusal attestation (no current program uses this tier)
Red — labs mandatory, with no patient bypass and no software override
Testosterone requires two morning total testosterone draws on separate days, plus LH, prolactin, SHBG, DHEA-S, CBC, PSA (≥ 40), and lipids
PrEP requires a negative 4th-generation HIV test before any prescription

04 / 06

Documented consent

◇ Telehealth, asynchronous review, privacy (PHIPA), and accuracy consents stored with every chart
◇ Informed-refusal attestations for any declined recommendation
◇ Consent text shown in full before signature — never buried

05 / 06

Pharmacist as second clinician

◇ A 5-minute pharmacist counselling call accompanies every first fill
◇ The pharmacist independently verifies identity and reviews interactions
Our pharmacy partner is a separate, OCP-accredited legal entity

06 / 06

Privacy under PHIPA

◇ Data stored in Canada on a PHIPA-aligned platform
◇ Audit logging on every access to your record
◇ Privacy impact assessment maintained and reviewed

The three lab tiers

Every program carries one of three laboratory policies, set by the physician — not by what is convenient to sell.

No labs required

This treatment does not require blood work.

EDPEWeight LossHair LossQuit SmokingADHDDoxyPEPLabs

Labs recommended

Blood work is recommended. You may decline — your physician will document informed refusal.

Labs required first

This treatment requires blood work before the prescription is released. Requisition is emailed after checkout.

PrEPTRT

Program protocols

The exact rules, per program.

These are the same rules the intake software enforces and your physician reviews against.

Erectile Dysfunction

No labs required

Any nitrate use (including "poppers") or riociguat/other PH agent → hard exclusion, absolute contraindication
MI/stroke/unstable angina < 6 months or exertional chest pain → hard exclusion
Priapism history or predisposing condition → hard exclusion
Sudden-onset ED → physician review
Alpha-blocker co-prescription → physician review, staggered dosing
Strong CYP3A4 inhibitor (ritonavir/ketoconazole/itraconazole) → hold, blocks approval; dose-limiting interaction, physician to adjust dose or select alternative
NAION / sudden monocular vision loss / retinitis pigmentosa → physician review
Uncontrolled hypertension or baseline hypotension → physician review
Penile curvature/deformity or Peyronie’s → physician review, possible urology referral
No routine lab work required

Premature Ejaculation

No labs required

Concurrent serotonergic medication → exclusion from serotonergic pathway
Bipolar disorder / mania history → hard exclusion
Acquired PE → physician review for underlying cause
Estimated latency > 3 minutes, or no reported loss of control/distress → physician review, diagnosis reconfirmed
Hepatic impairment → physician review, agent and dose selection
Syncope history → topical-first pathway
Comorbid ED → treat ED first

PrEP (HIV Prevention)

Labs required first

Known or previously positive HIV status → hard exclusion, immediate referral to HIV care
Potential exposure < 72 hours → exclusion + urgent PEP redirection (pre-payment safety gate)
Possible acute HIV symptoms → exclusion, testing first, same-day notification
Negative 4th-gen HIV Ag/Ab MANDATORY before initiation — no exceptions
Consent to quarterly HIV testing MANDATORY; declined → exclusion (pre-payment safety gate)
Prescriptions never exceed 90 days; quarterly HIV + STI results required for refills
Creatinine rechecked 30 days after initiation, then quarterly
Hepatitis B or C, renal impairment, or low bone mineral density → physician review
No ongoing exposure risk reported → physician review of indication

TRT (Testosterone)

Labs required first

Panel MANDATORY — two early-morning total testosterone draws on separate days, plus Free T, SHBG, LH, prolactin, DHEA-S, CBC, PSA ≥40, lipids; requisition emailed after checkout; no labs, no prescription
Diagnosis requires TWO low early-morning total testosterone results — a single or afternoon draw is never sufficient
Elevated prolactin or discordant LH → pituitary/endocrine workup before androgen therapy
Prostate or male breast cancer history → hard exclusion
MI, stroke, or venous thromboembolism within 6 months → hard exclusion
Actively trying to conceive → no testosterone; redirect to fertility-sparing pathway
Future fertility desired → mandatory counselling
Untreated severe OSA / remote thromboembolic event / erythrocytosis / severe heart failure → physician review
Non-prescribed prior androgen/steroid use → physician review, axis-suppression assessment
Monitoring: hematocrit + PSA on every refill cycle

Weight Management

No labs required

BMI < 27 → not eligible (auto-computed)
BMI 27–29.9 requires at least one weight-related comorbidity (hypertension, type 2 diabetes/prediabetes, dyslipidemia, or sleep apnea) → none reported = hard exclusion, monograph-enforced
MTC/MEN2 history → hard exclusion
Prior pancreatitis → hard exclusion
Pregnancy / planned conception < 2 months → hard exclusion
Insulin/sulfonylurea → physician review
Diabetic retinopathy → hold, blocks approval; ophthalmology follow-up confirmed before a GLP-1 is approved
Type 1 diabetes → physician review, GLP-1 not indicated for weight management
Eating disorder history → bupropion-naltrexone blocked (absolute); GLP-1 appropriateness reviewed separately
Seizure history, opioid/OAT use, abrupt alcohol/benzodiazepine/antiepileptic withdrawal, MAOI ≤ 14 days, or uncontrolled hypertension → bupropion-naltrexone and naltrexone blocked; GLP-1 pathway only
Current suicidal ideation → hard exclusion, 988 Suicide Crisis Helpline shown (pre-payment safety gate); past history only → physician review, documented monitoring plan
Gastroparesis or severe GI dysmotility → physician review before any GLP-1
Gallbladder disease/gallstones → physician review, biliary-risk counselling
Transferring GLP-1 care from another provider → physician review of agent, dose, and last injection date
No routine lab work required to start

Hair Loss

No labs required

Pregnancy / potential pregnancy → hard exclusion (finasteride teratogenicity)
Scalp inflammation or scarring → hard exclusion, refer in person
Patchy or diffuse-shedding pattern → physician review first
Current suicidal ideation → hard exclusion, 988 Suicide Crisis Helpline shown (pre-payment safety gate); prior mood symptoms on finasteride only → physician review
PSA-masking disclosure agreed and documented (finasteride halves PSA) — declined → physician review
Persistent sexual adverse-effect counselling acknowledged — not acknowledged → physician review

Quit Smoking

No labs required

MAOI use → hard exclusion (pre-payment safety gate)
Seizure or eating disorder history → bupropion blocked
Existing bupropion prescription → physician review, never stacked
Heavy alcohol use or abrupt cessation → physician review, seizure-threshold caution
Renal impairment → physician review, varenicline dose reduction
Recent cardiovascular event or uncontrolled cardiac disease → physician review, pathway selection
Time to first cigarette recorded — guides NRT starting dose
Pregnancy → behavioural first-line, physician review
Current suicidal ideation → hard exclusion, 988 Suicide Crisis Helpline shown (pre-payment safety gate); past history only → documented monitoring plan

ADHD

No labs required

Video visit MANDATORY before any controlled-substance prescription — no exceptions
No prior diagnosis/records → full assessment-from-scratch pathway (adult or pediatric), no stimulants on first asynchronous contact
Pediatric (6-17): guardian consent + relationship attestation required; mature minor (14+) assent documented separately from guardian consent
Pediatric: Teacher Assessment Form (or alternate second-setting informant) required to confirm multi-setting impairment before diagnosis
MAOI use → hard exclusion (pre-payment safety gate)
Cardiac risk factors → hold, blocks approval; ECG if indicated
Baseline height, weight, and known BP/HR recorded at intake; elevated readings → physician review before any stimulant
Pediatric: height and weight plotted on a growth chart at every follow-up; sustained growth deceleration → dose review or drug holiday discussed with the guardian
Seizure or eating disorder history → bupropion blocked (hold, blocks approval); stimulant or other non-stimulant only after physician review
Tic disorder or family history of tics → physician review; non-stimulant weighed
Active anxiety or depression → physician review, treatment sequencing documented
Glaucoma → physician review; non-stimulant pathway weighed
Substance use history → non-stimulant pathway preferred, documented
No routine lab work; BP/HR/weight tracked every follow-up
Limited quantities, no early refills, follow-up before every renewal

DoxyPEP (STI Prevention)

No labs required

Tetracycline allergy → hard exclusion
Pregnancy/breastfeeding → hard exclusion
Guideline population (gbMSM or transgender woman) WITH a bacterial STI in the past 12 months → indication met; anyone outside that → physician stewardship review
Counselling documented and acknowledged: full glass of water, stay upright 30–60 min, sun protection
HIV status recorded; unknown or positive → physician review; HIV-negative and not on PrEP → PrEP offered
Liver disease → physician review of doxycycline suitability
Current daily tetracycline use → physician review to avoid duplication
Not HIV prevention — PrEP discussed where relevant
STI screening recommended every 3–6 months

Lab Testing

No labs required

Clinical indication recorded in the patient’s own words — no requisition without one
Requisitions issued only after physician review
Abnormal results trigger direct physician follow-up
Sexual health screens include pre-test counselling documentation

What we will not do

No emergencies — chest pain, severe reactions, or crises go to 911 or an ER

No controlled substance ships without its own hard gate — stimulants (ADHD) require a live video visit before any prescription; testosterone (CDSA Schedule IV) is the one we prescribe fully asynchronously, gated instead by two lab-confirmed diagnostic draws

No patients under 18 — except ADHD assessment, offered ages 6+ with guardian consent

We only treat and ship within Ontario — confirmed before your file reaches a physician.

No oral isotretinoin, no opioid therapy, no benzodiazepines

No prescription without physician review — regardless of questionnaire score

Start an assessment

The rules we practise by, in public, in writing.The rules we practise by,

Identity, verified properly

One physician, accountable

Tiered laboratory gating

Documented consent

Pharmacist as second clinician

Privacy under PHIPA

The three lab tiersThe three lab tiers

The exact rules, per program.The exact rules, per program.

Erectile Dysfunction

Premature Ejaculation

PrEP (HIV Prevention)

TRT (Testosterone)

Weight Management

Hair Loss

Quit Smoking

ADHD

DoxyPEP (STI Prevention)

Lab Testing

What we will not doWhat we will not do

The rules we practise by, in public, in writing.The rules we practise by,

Identity, verified properly

One physician, accountable

Tiered laboratory gating

Documented consent

Pharmacist as second clinician

Privacy under PHIPA

The three lab tiersThe three lab tiers

The exact rules, per program.The exact rules, per program.

Erectile Dysfunction

Premature Ejaculation

PrEP (HIV Prevention)

TRT (Testosterone)

Weight Management

Hair Loss

Quit Smoking

ADHD

DoxyPEP (STI Prevention)

Lab Testing

What we will not doWhat we will not do

The rules we practise by,

The three lab tiers

The exact rules, per program.

What we will not do

The rules we practise by,

The three lab tiers

The exact rules, per program.

What we will not do