Informed Medical Consent

1. What Is Telemedicine?

Telemedicine is the delivery of healthcare services—including examination, consultation, diagnosis, and treatment—through electronic communication technologies when you (the patient) are located in a different location than your healthcare provider. Through the AMINO9 x Cyborg Platform, you may access telemedicine services provided by our Affiliated Providers.

2. Benefits of Telemedicine

Telemedicine provides several advantages:

•        Access to medical care from anywhere with an internet connection, including your home

•        Reduced exposure to illness in waiting rooms

•        Faster access to consultations without waiting for in-person appointments

•        Access to specialty care that may not be available in your community

•        Integration with your AMINO9 x Cyborg biomarker and health data for more informed consultations

3. Possible Risks of Telemedicine

As with any medical service, there are potential risks associated with telemedicine:

•        Technical failures (poor video quality, internet outages, service interruptions) may delay evaluation, consultation, or treatment. You may reschedule your visit if interruptions occur.

•        Security protocols could fail, causing a breach of privacy of personal medical information.

•        If you do not disclose sufficient information about your medical history, including diagnoses, treatments, medications, supplements, and allergies, adverse treatment outcomes, drug interactions, or allergic reactions may occur.

•        The electronic transmission of your personal health information carries inherent risks that cannot be completely eliminated.

TELEMEDICINE SERVICES ARE NOT EMERGENCY SERVICES. YOUR DATA WILL NOT BE MONITORED 24/7. IF YOU THINK YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL 911 (OR YOUR LOCAL EMERGENCY NUMBER) IMMEDIATELY.

THE CARE YOU RECEIVE WILL BE AT THE SOLE DISCRETION OF THE HEALTHCARE PROVIDER TREATING YOU, WITH NO GUARANTEE OF DIAGNOSIS, TREATMENT, OR PRESCRIPTION. The Provider will determine whether your condition is appropriate for a telemedicine encounter.

4. Your Rights and Acknowledgements

By accepting this Consent, you understand and acknowledge the following:

4.1 Accuracy of Information

You certify that providing false, misleading, or incomplete health information may result in incorrect treatment, delayed care, or harm. You are responsible for ensuring that all information you provide about your medical history and current condition is truthful, accurate, and complete.

4.2 Voluntary Participation

You may refuse a telehealth visit at any time without affecting your right to future care or treatment and without risking the loss of any benefits.

4.3 No Hidden Fees

There are no additional or hidden fees specifically associated with the use of telemedicine beyond your standard subscription or service fees.

4.4 Information Sharing

Your healthcare information may be shared with other individuals in accordance with the AMINO9 Cyborg Terms and Conditions and Privacy Policy, and applicable regulations or laws. You have the right to request disclosure of your Healthcare Information to any third party upon providing signed written authorization.

4.5 No Guaranteed Results

No results can be guaranteed or assured. You may not achieve the anticipated benefits of telemedicine services, and your condition may remain unchanged or worsen despite treatment. There is no guarantee that you will be issued a prescription; that decision rests solely with your Affiliated Provider’s professional judgment. Your Provider may determine that your condition requires in-person care and may refuse to prescribe medication and/or refer you accordingly.

4.6 Alternative Care

A variety of alternative methods of medical care may be available to you, and you may choose one or more of these at any time.

4.7 Medical Records

All information submitted to AMINO9 Cyborg will be part of your medical record. You have the right to review and receive copies of your medical records in accordance with applicable law. Contact support@amino9cyborg.com for access.

4.8 Non-Physician Providers

Your telemedicine visit may be with a non-physician Affiliated Provider (e.g., nurse practitioner, physician assistant). You may request that your visit be scheduled with a physician.

4.9 Location Verification

You will provide your accurate physical location when asked to ensure your Affiliated Provider is licensed to provide telemedicine services to you.

4.10 Technical Failures

You acknowledge that technical failures may occur beyond the control of AMINO9 Cyborg and your Affiliated Provider, and you agree to hold both harmless for such failures.

4.11 Primary Care Disclosure

You consent to the disclosure of any medical records prepared by AMINO9 Cyborg to your primary care provider.

4.12 California Residents

FOR CALIFORNIA RESIDENTS: You acknowledge receipt of the California Open Payments Database notice. The Open Payments Database is a federal tool for researching payments made by drug and medical device companies to physicians and hospitals, available at https://openpaymentsdata.cms.gov.

5. Consent Duration and Withdrawal

This Informed Medical Consent is valid for one (1) year from the initiation of your initial telemedicine visit. If you wish to withdraw consent, you must do so prior to receiving any further treatment by emailing us at:

support@amino9cyborg.com

Your withdrawal of consent will not affect your right to future care or treatment.

6. Complaints

To file a complaint against a physician, please contact the state medical board in your state. You can find contact information for all U.S. medical boards at: https://www.fsmb.org/contact-a-state-medical-board/

7. Acceptance

By accepting this Consent to Telehealth, you agree and acknowledge that you have read and understood this document, including potential risks, benefits, and your rights. By accepting, you consent to receive medical care via telehealth from Affiliated Providers through the AMINO9 x Cyborg Platform.

PATIENT ACKNOWLEDGMENT

I have read and understand this Informed Medical Consent form. I understand the risks, benefits, and my rights as described above. I voluntarily consent to receive telemedicine services through the AMINO9 x Cyborg Platform.

Patient Name (Print): ____________________________________________

Patient Signature: _______________________________________________

Date: ___________________________________________________________

Contact Information

Email: support@amino9cyborg.com

Mail:

AMINO9 Cyborg Health, Inc.

[Your Registered Address]

[City, State ZIP]