General Consent and Patient Agreement

Last Updated September 29th, 2021

BY CLICKING “I AGREE,” CHECKING A RELATED BOX TO SIGNIFY YOUR ACCEPTANCE, USING ANY OTHER ACCEPTANCE PROTOCOL, OR OBTAINING SERVICES FROM ANY MEDICAL PROVIDER, YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS GENERAL CONSENT AND PATIENT AGREEMENT. IF A PATIENT IS UNABLE TO CONSENT, YOU ACKNOWLEDGE THAT YOU AGREE TO THE TERMS OF THIS AGREEMENT AS THE LEGALLY AUTHORIZED REPRESENTATIVE OF PATIENT.

IF YOU HAVE A MEDICAL EMERGENCY, IMMEDIATELY CALL YOUR DOCTOR OR DIAL 911. The services made available to you through  CLINIC NAME may not be appropriate or all medical conditions or concerns.

 CLINIC NAME., f/k/a Praesidium Diagnostics, LLC (“ CLINIC NAME ”) is a technology company and provider of items and administrative services to healthcare providers, such as laboratories and medical practices.  CLINIC NAME helps facilitate communications with such providers. You have requested access to laboratory services from laboratories (“Labs”), and/or medical groups who provide healthcare services (“Medical Groups”). These medical groups may employ or contract with physicians, allied health professionals, and mental health professionals who offer certain healthcare and/or mental health services (“Providers”). Sometimes the Medical Groups and Providers are referred to herein collectively as “Medical Providers.”

 CLINIC NAME does not practice medicine itself, nor interfere with the practice of
medicine by Medical Groups or Providers, each of whom is solely responsible for the
medical care and treatment provided to you.  CLINIC NAME does not operate
laboratories, nor interfere with any services provided by the Labs, which are
responsible for the services they provide to you.

You understand and agree that visiting the  CLINIC NAME website and technology alone
does not create a patient relationship with any Medical Provider. A patient
relationship with a Medical Provider is only established when you have actually been
treated by a Provider of a Medical Group. In addition, you acknowledge and agree
that you have selected each Lab, Provider and Medical Group and elected to receive services from the Medical Providers and Labs and that no third-party, including  CLINIC NAME , has referred, suggested or recommended the Medical Providers and Labs to you.

CONSENT TO TREATMENT
You may be consulting with or receiving medical treatment or services from Medical
Providers, physicians, nurse practitioners, nurses, and other health professionals via
on-site appointments at locations operated by such Medical Providers, at-home, or
the through use of telehealth.

You acknowledge and agree that you have requested to receive medical treatment
and other healthcare items and services from Medical Providers and Labs, including,
without limitation, health evaluation and management services, health assessments,
primary care services, or laboratory panel services, and you consent to the rendering of medical treatment and other healthcare items and services as considered necessary and appropriate by Medical Providers at the time of the visit. You have the right to decline treatment and services at any time. You also acknowledge that no assurances or guarantees have been made to you by Medical Providers concerning the outcome and/or results of any medical treatment or services.

If a Medical Provider is not your primary care provider, it is your sole responsibility to
follow through with your primary care provider on any medical conditions or
treatments suggested in your treatment with Medical Provider, and to obtain a
medical examination by your primary care provider related to the findings, or lack of
findings, in your treatment with Medical Provider.

TELEHEALTH
Telehealth involves the delivery of healthcare and/or mental health services using
electronic communications, information technology or other means between a
healthcare or mental health provider and a patient who are not in the same physical
location. Telehealth may be used for diagnosis, treatment, follow-up and/or patient
education, and may include, but is not limited to, one or more of the following:
electronic transmission of medical records, photo images, personal health
information or other data between a patient and a provider; interactions between a
patient and provider via audio, video and/or data communications (such as
messaging or email communications); use of output data from medical devices,
sound and video files. Alternative methods of care may be available to you, such as in-person services, and you may choose an alternative at any time. Always discuss
alternative options with your Provider.

Anticipated Benefits. The use of telehealth may have the following possible
benefits: making it easier and more efficient for you to access medical care or other
services and treatment for the conditions treated by your Provider(s); allowing you
to obtain medical care or other services and treatment by Provider(s) at times that
are convenient for you; and enabling you to interact with Provider(s) without the
necessity of an in-office appointment. Potential Risks. While the use of telehealth in the delivery of care can provide potential benefits for you, there are also potential risks associated with the use of telehealth and other technology. These risks include, but may not be limited to the following: the quality, accuracy or effectiveness of the services you receive from your Provider could be limited; technology may contain bugs or other errors, including ones which may limit functionality, produce erroneous results, render part or all of such technology unavailable or inoperable, produce incorrect records, transmissions, data or content, or cause records, transmissions, data or content to be corrupted or lost; failures or limits of technology may also impact your Provider(s) ability to correctly diagnose or treat your condition; the inability of your Provider(s) to conduct certain tests or assess vital signs in-person may in some cases prevent the Provider(s) from providing a diagnosis or treatment or from identifying the need for emergency medical care or treatment for you; your Provider(s) may not able to provide treatment for your particular condition and you may be required to seek alternative healthcare or emergency care services; delays in medical evaluation/treatment could occur due to unavailability of your Provider(s) or deficiencies or failures of the technology or electronic equipment used; the electronic systems or other security protocols or safeguards used could fail, causing a breach of privacy of your medical or other information; data stored and communicated electronically, for example, through email communications, may be more susceptible to unintended disclosure of protected health information to third parties; given regulatory requirements in certain jurisdictions, your Provider(s) diagnosis and/or treatment options, especially pertaining to certain prescriptions, may be limited; a lack of access to all of your medical records may result in adverse drug interactions or allergic reactions or other judgment errors.

Data Privacy and Protection. The electronic systems will incorporate network and
software security protocols to protect the privacy and security of your information and will include measures to safeguard data against intentional or unintentional
corruption. Personal information that identifies you or contains protected health
information will not be disclosed to any third party without your consent, except as
authorized by law for the purposes of consultation, treatment, payment/billing, and
certain administrative purposes, or as otherwise set forth in your Provider's Notice of
Privacy Practices. You understand that  CLINIC NAME does not and cannot guarantee the security or privacy of the services you use to receive communications, including for example your email service provider.

THIRD PARTY GOODS AND SERVICES
Medical Providers and/or  CLINIC NAME may from time make available to you for
purchase or otherwise certain services devices, items or products (“Third-Party
Goods and Services”), manufactured, distributed or sold by parties other than
 CLINIC NAME or Provider (“Third-Parties”). Some of these Third-Party Goods and
Services may include devices that have not been reviewed or approved by the Food
and Drug Administration (“FDA”) or may only be approved by the FDA for limited
uses or purposes. In making these Third-Party Goods and Services available to you,
 CLINIC NAME , Provider, and their respective employees, contractors, and/or agents,
including Medical Providers, are not recommending or condoning any such Third-
Party Goods and Services, or providing any kind of promises or representations
about their effectiveness. Your use of any Third-Party Goods and Services, including
the use of any device that has not been approved by the FDA, and any interactions
with Third-Parties, including payment and delivery of goods or services, and any
other terms, conditions, warranties or representations associated with such use or
interactions, are solely between you and such Third-Parties. You should make
whatever investigation you feel necessary or appropriate before proceeding with any transaction involving Third-Parties or using any Third-Party Goods and Services.

You agree that  CLINIC NAME and Medical Providers shall not be responsible or liable
for any loss or damage of any sort incurred as the result of your use of any Third-
Party Goods and Services or your interactions with any Third-Parties. In the event
of any dispute between you and any Third-Party or any other entity or individual,
you understand and agree that the Provider and  CLINIC NAME are under no obligation
to become involved in such dispute, and you hereby release and indemnify the
Provider and  CLINIC NAME from any and all claims, demands and/or damages (actual
or consequential) of every kind or nature, known or unknown, suspected and
unsuspected, disclosed or undisclosed, arising out of or in any way related to such
disputes, the Third-Party Goods and Services or features and services therein. If
you are a California resident, you waive California Civil Code Section 1542, which
states: “A general release does not extend to claims which the creditor does not
know or suspect to exist in his or her favor at the time of executing the release,
which, if known by him or her must have materially affected his or her settlement
with the debtor.”

INFORMED CONSENT/DISCLOSURE OF RISKS RE PARTICULAR ITEMS AND
SERVICES

By obtaining the below items and services, you agree that you have carefully
reviewed the below disclosures and have been informed of the risks associated with these items and services. The below disclosures include some risks associated with these items and services, but there are other general risks associated with these items and services, as well as risks that may be unique to your circumstances. You should discuss any questions that you have with any items or services with your treating Provider or primary care physician.

INJECTIONS
Intramuscular (or IM) injection involves the injection of a substance directly into a
muscle. IM injections are used for particular forms of nutrients and that are
administered in small amounts (1-3cc). Depending on the compounds injected, they
may be absorbed fairly quickly or more gradually. Provider staff will administer the
IM injection into the deltoid muscle (shoulder).

Proper diagnosis and treatment of a medical condition requires a formal office visit
with a medical physician. Thrombocytopenia (low platelet counts) and coagulopathy
(bleeding tendency) are contraindications for intramuscular injections, as they may
lead to bruising and/or excessive bleeding. A routine blood test is recommended at
least yearly to assess proper organ function. There are risks and hazards related to
the performance of any injection. These risks include pain, erythema (redness), local
edema (swelling), bleeding, bruising, injection fibrosis (scar tissue formation),
headache, lightheadedness, and allergic reaction. Immediate medical attention may
be necessary if you have a significant adverse reaction. Adverse reactions requiring
immediate attention include, but are not limited to, fever of 101oF, chills, redness,
drainage, or swelling at the injection site.

CONSENT FOR IV-THERAPY
This document is intended to serve as confirmation of informed consent for IV therapy. You are responsible to inform your Provider of any known allergies to drugs,
supplements, or other substances that may be included in the ingredients of my
solutions, or of any past reactions to anesthetics. You are responsible to inform your
Provider of all current medications and supplements, and of all medical conditions,
diseases, and illnesses.

You understand that IV therapy carries with it both risks and benefits. Some of those
risks and benefits include, but are not limited to:


The Risks and potential side effects
1. Discomfort, soreness, bleeding, bruising, pain and possible scarring at the site of
injection.
2. Inflammation of the vein used for injection, phlebitis, metabolic disturbances,
and injury.
3. Lightheadedness or fainting.
4. Severe reaction to medication, supplement or vitamin therapy; anaphylaxis,
cardiac arrest or death.
5. Volume overload.
6. Air embolism.
7. Infiltration

The Benefits
1. Injectables are not affected by stomach or intestinal disease.
2. Total amount of infusion enters the bloodstream and is available to the tissues.
3. Higher doses of nutrients can be given by vein than by mouth,
4. Can be used in conjunction with oral supplementation and/or dietary and
lifestyle changes. You are aware that other unforeseeable complications could occur. You understand the risks and benefits of the procedure and you have had or will have an opportunity to have all of your questions answered. You understand that you have the right to consent to or refuse any proposed treatment at any time before or during its performance.

COVID-19 TESTING SERVICES

BACKGROUND ON TESTING SERVICES:  CLINIC NAME , together with our affiliated Labs and Medical Groups, is pleased to facilitate COVID-19 testing. This includes the performance of testing by various means (including nasal swab specimens) by individuals who have opted-in for COVID-19 testing (hereinafter “COVID-19 testing”). Following processing of tested specimens, you will be notified of your COVID-19 testing results.

CONSENT TO COVID-19 TESTING: You hereby agree to undergo COVID-19 testing in accordance with the instructions provided to you, including cooperation with all
healthcare professionals and personnel to collect an appropriate specimen safely and effectively. You agree to comply with all instructions provided to you related to
administration of the COVID-19 testing kit. You further acknowledge that the COVID-19 testing kit is available as a result of the U.S. Food and Drug Administration’s Emergency Use Authorization (“EUA”) process under section 564 of the Federal Food, Drug, and Cosmetic Act. EUAs make available diagnostic and therapeutic medical devices to diagnose and respond to public health emergencies by allowing unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by chemical, biological, radiological and nuclear threat agents when there are no adequate, approved, and available alternatives. As a result, the COVID-19 testing kit is subject to certain limitations. You understand that as with any type of medical or health related test, procedure or treatment, certain risks apply. COVID-19 testing risks include the risk of injury as the result of administering the test; the risk of improper administration; and inaccurate test results.

In addition to the foregoing you acknowledge the following:
RISKS OF DISCOMFORT: Testing may involve discomfort, including pain, tearing
up, and/or triggering a gag reflux.
RISK OF INACCURACY: There is a risk the test will result in a false positive or false
negative result, and a positive or negative test result does not mean there are no
additional possible adverse health conditions or outcomes I may experience.
RISK OF EXPOSURE: Being present in the same space as others, despite my own
efforts and those of the health professionals working with me, may increase the risk of my exposure to COVID-19 and the novel coronavirus (SARS-CoV-2). Even following best practices, it is possible for me and Provider personnel to be unaware that we are contagious even without symptoms, raising the possibility of infection. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death.
RISK OF DISCLOSURE: The U.S. Centers for Disease Control and Prevention and
the Los Angeles County Department of Public Health requires the Provider and the
laboratory processing my specimen to report my test results, whether positive or
negative, to my local public health authority. In addition to the test results, Praesidium will report certain personal information, not limited to, my age, sex, ethnicity, and zip code. You understand that although Praesidium implements a wide range of administrative, physical, and technical safeguards to protect health information and comply with HIPAA, it cannot guarantee the privacy and confidentiality of all health information. For more details, please review our Notice of Privacy Practices.
SEEK OTHER SOURCES OF CARE FOR OTHER HEALTH NEEDS: Please note that
Praesidium does not take direct responsibility for your health or care beyond facilitating needed testing. Our services are limited to COVID-19 testing. The physicians who order tests are not your doctors for any other purposes. You need to seek other sources of care for your healthcare needs, including to examine any other health issues you may experience and to treat you for COVID-19 or any other conditions you have.
TESTING LIMITATIONS: I understand the Test is available as a result of the FDA’s
Emergency Use Authorization (“EUA”) under Section 564 of the Federal Food, Drug, and Cosmetic Act. The EUA’s make available diagnostic tests to diagnose and respond to public health emergencies by allowing unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by chemical, biological, radiological and nuclear threat agents when there are no adequate, approved, and available alternatives. As a result, Testing may be subject to certain limitations as set forth in this Informed Consent.
NOT FOR EMERGENCIES: Praesidium does not provide healthcare on an
emergency basis anywhere at any time and is not a substitute for your physician. Please do not delay seeking care from in a medical emergency or in place of your doctor. In an emergency, dial 911 or go to a hospital emergency department.
RIGHT TO DECLINE CLIENT: Please understand that Praesidium reserves right to
refuse to provide collection kits, if, in Praesidium’s judgment, you are not a good candidate for our services.
AGREEMENT TO ANSWER THE ONLINE QUESTIONNAIRE TRUTHFULLY AND USE SERVICES HONESTLY: You accept the responsibility to provide full and truthful answers to all questions and, when requested, to provide all other data in the most accurate form possible. If you do not understand anything in this Consent, do not proceed.
Data Sharing: When booking a test with a prepaid discount code created by your
employer or supervisor you consent for the data to be shared with your employer
including any medical results or other health information related to the delivery of
service. If you do not consent for your results to be shared with your employer or
supervisor yet still want to use the pre-booked test please reach out to support@ CLINIC NAME -testing.com.
DISCLOSURE OF PROVIDER INFORMATION & PATIENT GRIEVANCES: All the Medical Group’s Providers are licensed, certified or otherwise permitted to provide medical services in the state where medical services are provided. Your treating provider’s information, including name, highest level of academic degree, specialty, license status, and license number, and board certification (where applicable) are available to you at request at the time of treatment and displayed where required.

Should you have any questions, comments, feedback or grievances concerning your treating Provider, the Medical Group’s clinical team or other staff, and/or the treatment you received, you may always reach out directly to the Medical Group at support@ CLINIC NAME -testing.com.

Additionally, patients always have the right to report concerns or grievances to the
appropriate state medical Board, or other applicable regulatory body. The Medical
Group will provide you with information regarding how to contract such regulatory
bodies and will post such information as required by law. You may, at any time, request that the Medical Group provide you with that information again.

LIMITATION OF LIABILITY
IN NO EVENT SHALL  CLINIC NAME BE LIABLE TO YOU OR ANY OTHER PERSON
OR ENTITY FOR ANY DAMAGES (INCLUDING, WITHOUT LIMITATION,
INCIDENTAL AND CONSEQUENTIAL DAMAGES, PERSONAL INJURY OR
WRONGFUL DEATH, LOST PROFITS, OR DAMAGES RESULTING FROM LOST
OR CORRUPTED DATA OR BUSINESS INTERRUPTION) RESULTING FROM THE
USE OF OR INABILITY TO USE ANY TECHNOLOGY, INCLUDING THE SERVICE,
OR ANY THIRD-PARTY GOODS AND SERVICES, WHETHER BASED ON
WARRANTY, CONTRACT, TORT (INCLUDING NEGLIGENCE), OR ANY OTHER
LEGAL THEORY, AND WHETHER OR NOT ADVISED OF THE POSSIBILITY OF
SUCH DAMAGES.  CLINIC NAME SHALL BE LIABLE ONLY TO THE EXTENT OF
ACTUAL DAMAGES INCURRED BY YOU, NOT TO EXCEED U.S. $1,000.

 CLINIC NAME SHALL NOT BE LIABLE FOR ANY PERSONAL INJURY, INCLUDING
DEATH, CAUSED BY YOUR USE, MISUSE OR INABILITY TO USE ANY
TECHNOLOGY, INCLUDING THE SERVICE, OR ANY THIRD-PARTY GOODS AND
SERVICES. ANY CLAIMS ARISING IN CONNECTION WITH YOUR USE OF ANY
TECHNOLOGY, INCLUDING THE SERVICE, OR ANY THIRD-PARTY GOODS AND
SERVICES MUST BE BROUGHT WITHIN ONE (1) YEAR OF THE DATE OF THE
EVENT GIVING RISE TO SUCH ACTION OCCURRED. YOU UNDERSTAND AND
AGREE THAT YOUR USE OF ANY TECHNOLOGY, INCLUDING THE SERVICE,
AND ANY THIRD-PARTY GOODS AND SERVICES IN CONNECTION WITH
FORWARD IS PREDICATED UPON YOUR WAIVER OF ANY RIGHT TO
PARTICIPATE IN A CLASS ACTION SUIT AGAINST FORWARD FOR ANY LOSSES
OR DAMAGES RESULTING FROM YOUR USE OF SUCH TECHNOLOGY OR
THIRD-PARTY GOODS AND SERVICES.

SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OF CERTAIN
WARRANTIES OR THE LIMITATION OR EXCLUSION OF LIABILITY FOR
INCIDENTAL OR CONSEQUENTIAL DAMAGES. TO THE EXTENT THAT WE MAY
NOT DISCLAIM ANY IMPLIED WARRANTY OR LIMIT ITS LIABILITIES, THE
SCOPE AND DURATION OF SUCH WARRANTY AND THE EXTENT OF OUR
LIABILITY WILL BE THE MINIMUM PERMITTED UNDER APPLICABLE LAW.

Binding Arbitration/Class Waiver
a. MANDATORY ARBITRATION OF CLAIMS.


i. ALL DISPUTES, CONTROVERSIES, AND CLAIMS ARISING OUT OF OR RELATED TO THIS AGREEMENT, ANY MEDICAL CARE AND SERVICES PROVIDED BY CLINIC NAME OR MEDICAL PROVIDERS, INCLUDING ANY CLAIM OF MEDICAL MALPRACTICE OR PRODUCT LIABILITY, WILL BE RESOLVED EXCLUSIVELY AND FINALLY BY BINDING ARBITRATION ON AN INDIVIDUAL BASIS. EACH PARTY EACH HEREBY WAIVES ITS RIGHTS TO PROCEED WITH MATTERS, CLAIMS, DISPUTES, CONTROVERSIES, OR CAUSES OF ACTIONS IN A COURT OF LAW OR BEFORE A JUDGE OR JURY. OTHER RIGHTS THAT THE PARTIES WOULD HAVE IF THE PARTIES WENT TO COURT MAY ALSO BE UNAVAILABLE OR MAY BE LIMITED IN ARBITRATION.

ii. TO THE EXTENT LEGALLY PERMITTED, EACH PARTY SHALL ADVANCE ITSOWN
COSTS, EXPENSES, AND FEES IN AN ARBITRATION HEREUNDER, WITH REASONABLE FEES AND COSTS AWARDED TO THE SUBSTANTIALLY PREVAILING PARTY IN ANY ARBITRATION ARISING HEREUNDER. ARBITRATION SHALL BE CONDUCTED BY THE AMERICAN ARBITRATION ASSOCIATION (“AAA”) IN ACCORDANCE WITH THE AAA CONSUMER ARBITRATION RULES THEN IN EFFECT (OR IF NO LONGER IN EFFECT AT THE TIME A DEMAND FOR ARBITRATION IS BROUGHT HEREUNDER, THEN THE RULES OF ARBITRATION WHICH ARE GENERALLY ACCEPTED AS BEING THE SUCCESSOR OF THE AAA
CONSUMER ARBITRATION RULES), BEFORE A SINGLE, NEUTRAL ARBITRATOR TO BE MUTUALLY SELECTED BY THE PARTIES. TO THE EXTENT PERMITTED BY THE ARBITRATOR, THE ARBITRATOR WILL CONDUCT ANY HEARINGS BY TELEPHONIC OR VIDEO CONFERENCE APPEARANCE, RATHER THAN IN-PERSON. ANY AWARD RENDERED IN AN ARBITRATION PROCEEDING HEREUNDER SHALL BE FINAL AND BINDING ON EACH OF THE PARTIES, AND JUDGMENT MAY BE ENTERED THEREON IN ANY COURT OF COMPETENT JURISDICTION. THIS AGREEMENT TO ARBITRATE SHALL BE ENFORCEABLE
UNDER AND SUBJECT TO THE FEDERAL ARBITRATION ACT, 9 U.S.C. §§ 1, ET SEQ.

iii. FOR QUALIFYING CLAIMS, A PARTY MAY ELECT TO PURSUE YOUR CLAIM ON AN INDIVIDUAL BASIS IN SMALL-CLAIMS COURT, RATHER THAN VIA ARBITRATION.

b. CLASS ACTION WAIVER. THE PARTIES AGREE THAT – FOR ANY MATTERS, CLAIMS, DISPUTES, CONTROVERSIES, OR CAUSES OF ACTIONS BETWEEN YOU AND  CLINIC NAME AND/OR OUR MEDICAL PROVIDERS THAT ARISE OUT OF AND/OR RELATE TO THESE TERMS, THE SERVICES OFFERED BY  CLINIC NAME OR MEDICAL PROVIDERS, AND/OR THE PRODUCTS OR SERVICES OF A THIRD PARTY OFFERED IN CONJUNCTION WITH THOSE SERVICES –NO PARTY MAY JOIN OR CONSOLIDATE CLAIMS OR OTHERWISE PARTICIPATE IN ANY CLAIM AS A CLASS MEMBER, CLASS REPRESENTATIVE, OR PRIVATE ATTORNEY
GENERAL. THE PARTIES AGREE THAT THE ARBITRAL TRIBUNAL MAY NOT CONSOLIDATE


MULTIPLE PERSONS’ CLAIMS, PRESIDE OVER ANY REPRESENTATIVE OR CLASS
PROCEEDING, OR CONSIDER THE ENFORCEABILITY OF THIS CLASS ACTION WAIVER.