PHARMXHEALTHONE MASTER CONSENT & TREATMENT AGREEMENT

Last updated: July 2, 2025

Nationwide Telehealth + Local In-Clinic Services
Medical Weight Loss | Peptide Therapy | Hormone Therapy | Exosome Therapy

This Master Consent & Treatment Agreement (“Agreement”) outlines the terms, responsibilities, risks, and conditions under which PharmXHealthOne provides its clinical services. By signing this Agreement, I (“Patient,” “I,” “me,” or “my”) acknowledge that I have read, understood, and voluntarily agree to all sections herein.

SECTION 1: PROGRAM OVERVIEW

PharmXHealthOne provides integrative, medically supervised treatment programs including:

1.1 Medical Weight Loss
Includes medications such as Semaglutide, Tirzepatide, or other clinically appropriate agents (FDA-approved or compounded, depending on availability and state law).

1.2 Peptide Therapy
May include peptides such as BPC-157, CJC-1295/Ipamorelin, GHK-Cu, MOTS-C, TB-500, and others. Many peptides are not FDA-approved and may be prescribed off-label based on clinical discretion.

1.3 Hormone Replacement Therapy (HRT)
May include testosterone, estrogen, progesterone, thyroid optimization, adrenal support, or related therapies. Some hormone therapies involve controlled substances.

1.4 Exosome Therapy
Includes consultation, prescription, ordering, and local IV administration only in Florida. Exosomes for IV use are not FDA-approved for any medical condition.

1.5 Telehealth Services
Most services are delivered nationwide via telehealth, subject to state-specific rules. Local services are offered at the Boynton Beach, Florida clinic.

SECTION 2: TELEHEALTH CONSENT

2.1 I consent to receive evaluation, diagnosis, and treatment through telehealth technologies including video, audio, text messaging, or electronic platforms.

2.2 I understand telehealth involves risks, including possible interruptions, technical failures, or unauthorized access despite HIPAA-compliant systems.

2.3 I agree to provide accurate medical history and information during all telehealth encounters.

SECTION 3: STATE REGULATION ACKNOWLEDGMENT

I understand:

3.1 Some medications (especially compounded drugs, controlled substances, and certain peptides) may not be available in my state due to telemedicine or pharmacy regulations.

3.2 Some states require:

• An initial in-person physical exam

• In-state labs

• Enhanced documentation of medical necessity

• Prohibition of certain compounded substances

3.3 PharmXHealthOne must comply with all federal and state laws and may decline treatment if regulations prevent prescribing.

SECTION 4: MEDICATION DISCLOSURES

4.1 FDA-Approved vs. Compounded Medications

I understand:

• Branded FDA-approved medications (e.g., Wegovy, Zepbound, Ozempic, Mounjaro) may be prescribed if clinically appropriate.

• Compounded Semaglutide, compounded Tirzepatide, or other compounded medications are not FDA-approved, but are prepared by licensed U.S. compounding pharmacies under FDA 503A/503B regulations.

4.2 Off-Label Use

Some medications, peptides, exosomes, and hormones may be used off-label, which is a legal and common medical practice.

4.3 Pharmacy Fulfillment

I understand that:

• Pharmacies control shipping times and formulation preparation

• Medication delays are outside PharmXHealthOne’s control

• Compounded medication fees are non-refundable once pharmacy processing begins

SECTION 5: RISKS, SIDE EFFECTS & CONTRAINDICATIONS

I understand that every treatment category has risks.

5.1 Medical Weight Loss Risks

Possible risks include nausea, vomiting, dehydration, pancreatitis, gallstones, kidney complications, hypoglycemia, and potential thyroid risks.

5.2 Peptide Therapy Risks

Possible risks include injection-site irritation, headaches, dizziness, appetite changes, fatigue, allergic reactions, or unknown long-term effects (for research peptides).

5.3 Hormone Therapy Risks

Potential risks may include mood changes, acne, increased red blood cell count, fertility changes, prostate or breast health considerations, cardiovascular risks, or fluid retention.

5.4 Exosome Therapy Risks

I understand that:

• Exosome therapy is not FDA-approved for treatment or prevention of any condition

• Possible risks include immune reactions, infusion reactions, fever, chills, fatigue, or unknown long-term risks

5.5 Pregnancy & Breastfeeding

I agree to discontinue treatment and notify PharmXHealthOne immediately if I become pregnant or suspect pregnancy.

SECTION 6: TREATMENT RESPONSIBILITIES

I agree to:

• Follow medication instructions exactly

• Attend all required follow-up visits

• Complete all required labs in a timely manner

• Report side effects or health changes promptly

• Not share medications with anyone

• Use prescribed medications only for myself

• Maintain regular care with my primary care provider

SECTION 7: RESULTS & LIMITATIONS

I acknowledge that:

• No treatment guarantees weight loss, fat loss, muscle gain, hormonal improvement, hair restoration, anti-aging results, or symptom resolution

• Results vary significantly between individuals

• Marketing examples and testimonials are not promises or guarantees

SECTION 8: LOCAL VS. NATIONWIDE SERVICE AVAILABILITY

I understand:
8.1 Nationwide via Telehealth:

• Weight loss medications

• Peptide therapy

• Hormone therapy

• Exosome consultations & ordering

• Functional medicine services

8.2 Local Florida Only (Boynton Beach + 20-mile radius):

• IV therapies (including Exosome IV Therapy)

• Body contouring treatments

• Laser and device-based treatments

• Any service requiring medical equipment or hands-on operation

SECTION 9: FINANCIAL TERMS & REFUND POLICY

I acknowledge:

9.1 Program fees, medication costs, labs, and follow-ups are my responsibility.
9.2 Insurance typically does not cover compounded medications or wellness programs.
9.3 Once medications are ordered or labs are drawn, fees are non-refundable.
9.4 PharmXHealthOne maintains the right to adjust pricing or discontinue services as needed.

SECTION 10: TERMINATION OF CARE

PharmXHealthOne may suspend or discontinue treatment if:

• I provide false or incomplete medical information

• I fail to complete required labs or follow-ups

• I engage in abusive or inappropriate communication

• My health condition contraindicates continued treatment

• State or federal laws restrict further prescribing

I may withdraw from treatment at any time, understanding previously paid fees may not be refundable.

SECTION 11: PRIVACY, HIPAA & ELECTRONIC COMMUNICATION

I consent to:

• The storage and transmission of my medical information in HIPAA-compliant systems

• Receiving electronic communication (email, text, or portal) related to appointments, follow-ups, or treatment

• The use of telehealth platforms for clinical services

SECTION 12: INDEMNIFICATION

I agree to indemnify and hold harmless PharmXHealthOne, its medical providers, affiliates, staff, and pharmacies from liability arising from:

• Failure to follow treatment instructions

• Misuse of medications

• Withholding medical information

• Unauthorized modification of dosage

• Non-compliance with follow-up requirements

SECTION 13: ACKNOWLEDGMENT OF UNDERSTANDING

By continuing and agreeing to receive services or treatment from us you confirm below:

• I affirm that I have read and understand all sections

• I have had the opportunity to ask questions

• I voluntarily consent to all treatments prescribed by PharmXHealthOne providers

• I accept all risks, responsibilities, and limitations of treatment

• I understand that this document governs all current and future treatments under PharmXHealthOne