Patient Consent, Waiver, and Acknowledgment Agreement - Naos Wellness Group
This document serves as acknowledgment of the terms and responsibilities associated with participation in the services of Naos Wellness Group. By signing, I affirm that I have been informed, understand, and voluntarily accept the provisions contained in this form.
I acknowledge that Naos Wellness Group provides wellness and health optimization services which may include weight management interventions, nutritional supplementation, lifestyle counseling, and peptide based therapies. I understand that certain therapies, including peptide compounds, may not be approved by the United States Food and Drug Administration for the precise indications under which they are provided, and that such use may be considered off label. I willingly consent to receive these services with full knowledge of this information.
I understand that services may be delivered online through telemedicine and that such services have limitations compared to in person evaluations. I accept that these services are not intended to replace urgent or emergency medical care and that I remain responsible for seeking emergency care when necessary.
By signing this agreement I confirm that I have disclosed a complete and accurate medical history, including medications, allergies, and past conditions. I acknowledge that all disclosures must be provided in this form or by email before signing, and that I remain fully responsible for any omissions.
I further acknowledge and accept the following:
• No guarantee of outcome, specific benefit, or result has been promised or implied, and potential risks or side effects may occur.
• I accept responsibility for storage, use, and proper disposal of any medications or products, and for keeping them safely away from children and pets.
• All sales are final, there are no refunds, replacements, or exchanges regardless of results or tolerance, and payment is due at the time of purchase.
• Shipping and delivery processes are subject to variation, and Naos Wellness Group is not liable for delays, errors, or interruptions outside of its control.
• My personal health information will be kept confidential, though I acknowledge the limits of electronic communication such as email or text.
• I grant permission for Naos Wellness Group to share general stories and progress pictures for educational or promotional purposes as long as no personally identifiable information is disclosed.
• I consent to being contacted for follow ups, refill reminders, and information related to my treatment.
• I release, discharge, and hold harmless Naos Wellness Group, its providers, staff, and affiliates from any liability, claims, or causes of action related to these therapies, including any undesired effects or outcomes.
By signing below I affirm that I have read and understood or had the opportunity to understand this agreement, and I voluntarily accept all terms and conditions contained in this consent.
