Medical Consent

Medical Media Partners LLC (DBA: Overnight-WeightLoss.com)

Last updated: September 12, 2024.

OUR PROVIDERS DO NOT ADDRESS MEDICAL EMERGENCIES. DO
NOT PROCEED WITH CLINICAL SERVICES USING THE OVERNIGHT WEIGHT LOSS PLATFORM IF
YOU BELIEVE YOU ARE HAVING A MEDICAL EMERGENCY. IF YOU BELIEVE YOU ARE
EXPERIENCING A MEDICAL EMERGENCY, YOU SHOULD DIAL 9-1-1 AND/OR GO TO THE
NEAREST EMERGENCY ROOM. IF YOU ARE CONTEMPLATING SUICIDE, CONTACT 911 OR THE
NATIONAL SUICIDE PREVENTION LINE BY ONE OF THE FOLLOWING METHODS:

DIAL 1-800-273-TALK

DIAL OR TEXT 988

Go to 988Lifeline.org to chat LIVE

I. Introduction

You are reviewing and acknowledging this Telehealth
Informed Consent because you are seeking Healthcare Services utilizing
telehealth technologies by the Overnight Weight Loss facilitated through the Overnight
Weight Loss Anti-Aging Inc. DBA Overnight Weight Loss, Inc. website, iOS mobile
app, web mobile app or other telehealth technologies collectively the “Overnight
Weight Loss Anti-Aging Inc. DBA Overnight Weight Loss Platform.” This
Telehealth Informed Consent does not modify or supersede any Terms of Use,
Privacy Policy, or Notice of Privacy Practices of Overnight Weight Loss
Anti-Aging Inc. DBA Overnight Weight Loss or the Providers, rather it
supplements these terms and documents.

By creating an account, starting a consult, clicking
“I consent to telehealth,” checking a related box to signify your acceptance,
or using any other acceptance protocol presented through the Overnight Weight
Loss Anti-Aging Inc. DBA Overnight Weight Loss Platform, you indicate that you
have reviewed the risks as described herein of receiving services utilizing
telehealth technologies and consent to receiving the services. A record of this
Telehealth Informed Consent is maintained in the files and records of the
applicable Provider delivering your services, and your on-going participation
in services by the Overnight Weight Loss using telehealth technologies serves
as an on-going acknowledgement of your acceptance of this Telehealth Informed
Consent and updates at such time the representations you provide herein.

Overnight Weight Loss refers to a network of medical
professional organizations affiliated with Overnight Weight Loss Anti-Aging
Inc. DBA Overnight Weight Loss, Inc. and its employed and contracted health
providers (the “Providers”).

II. What is
Telehealth?

Telehealth involves the delivery of health and
wellness services using electronic communications, information technology, or
other means between a licensed, certified, or registered healthcare
professional at one location and a patient in another location about a clinical
matter. Telehealth may be used for diagnosis, treatment, follow-up and/or
patient education. These telehealth services may involve various modalities,
including asynchronous interactions, real-time (synchronous) video and audio
encounters, and interactive audio with store and forward. This “Telehealth
Informed Consent” informs the patient (“patient,” “you,” or “your”) concerning
the treatment methods, risks, and limitations of utilizing telehealth to meet
your health and wellness needs.

III. What are the
Possible Benefits of Telehealth?

Benefits of telehealth include being easier and more
efficient for you to access health and wellness services. You can obtain health
and wellness services at times that are convenient for you without the
necessity of an in-office appointment, including follow-up care related to your
treatment. If you need follow-up care, please contact us through the Overnight
Weight Loss Anti-Aging Inc. DBA Overnight Weight Loss Platform or the Overnight
Weight Loss Anti-Aging Inc. DBA Overnight Weight Loss call center at

727-699-2739 Mon – Sun 9:00 am EST – 6:00 pm EST

IV. What are the
Possible Risks of Telehealth?

Information transmitted to your health professional
may not be sufficient to allow for appropriate health or wellness services to
meet your particular need. Some clinical needs may not be appropriate for a
telehealth visit and your Provider will make that determination. The technology
necessary to interact with your health professional may fail and delay your
services. If a technical failure prevents you from communicating with your
Providers, you should call the following number:

Phone: 727-699-2739 Mon – Sun 9:00 am EST – 6:00 pm
EST

In rare events, a lack of access to complete
medical records, and/or the quality of transmitted data could result in adverse
drug interactions, allergic reactions, and/or other clinical judgment errors.
You may stop or decline any on-going Healthcare Services provided by Overnight
Weight Loss using telehealth technologies at any time, although you acknowledge
that applicable fees may apply if a medical consultation has occurred prior to
request to cancel services and Overnight Weight Loss has no obligation for your
on-going care or selection of separate healthcare services in such
circumstances.

I understand that certain diagnostic testing services,
including laboratory products and services offered through the Overnight Weight
Loss Anti-Aging Inc. DBA Overnight Weight Loss Platform to support the
Healthcare Services of Providers, may contain defects, including ones which may
limit functionality or produce erroneous results, any or all of which could
limit or otherwise impact the quality, accuracy and/or effectiveness of the
medical care or other services that I receive from my Provider(s).

THIRD-PARTY LABORATORY PRODUCTS AND SERVICES To
facilitate certain Healthcare Services Providers may require that you complete
diagnostic test(s). These diagnostic tests are provided by third-party
laboratories, and neither Overnight Weight Loss Anti-Aging Inc. DBA Overnight
Weight Loss, Overnight Weight Loss, nor your Provider(s) can guarantee the
accuracy or reliability of these tests. These laboratory tests can provide
false negative, false positive, or inconclusive results that could impact your
Provider(s) ability to correctly diagnose or treat your medical conditions. A
failure or defect of these tests could also impact your Provider(s) ability to
correctly diagnose or treat your medical conditions.

V. Patient
Acknowledgments

By accepting this Telehealth Informed Consent, you
acknowledge you understand and consent to the following:

You have reviewed this Telehealth Informed Consent
carefully, and understand there are risks, limitations, and benefits of
utilizing telehealth.

You understand that the electronic nature of the
telehealth services means that there is a greater risk to the privacy of my
health information.

In some cases, my Provider may be a nurse practitioner
or physician assistant and not a physician.

Persons may be present during the telehealth visit
other than my Provider in order to operate the telehealth technologies and/or
for language translation assistance, if requested. If another person is present
during the telehealth visit, I will be informed of the individual’s presence
and his or her role.

I understand that information I provide as part of any
telehealth offering is viewed as accurate, true, and complete.

I understand that in certain instances, and in
compliance with applicable law, my Provider may determine that it is
appropriate to provide my Healthcare Services asynchronously via
store-and-forward technology. In such instances, my Provider and I will communicate
electronically through the Overnight Weight Loss Anti-Aging Inc. DBA Overnight
Weight Loss Platform and not via telephone or video. I agree that if my
provider makes that determination, I would like to receive Healthcare Services
in this manner.

I understand that there is no guarantee that I will be
given a prescription and that the decision of whether a prescription is
appropriate will be made in the professional judgment of my Provider. I
understand that while the use of telehealth may provide benefits to me, no such
benefits or specific results can be guaranteed and my condition may not
improve.

I understand there is a risk of technical failures
during the telehealth encounter beyond the control of Overnight Weight Loss and
my Provider(s). I AGREE TO HOLD HARMLESS OVERNIGHT WEIGHT LOSS AND ITS
EMPLOYEES, CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS,
OFFICERS, REPRESENTATIVES, ASSIGNS, PREDECESSORS, AND SUCCESSORS, INCLUDING Overnight
Weight Loss Anti-Aging Inc. DBA Overnight Weight Loss AND ITS EMPLOYEES,
CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS,
REPRESENTATIVES, ASSIGNS, PARENTS, PREDECESSORS, AND SUCCESSORS FOR DELAYS IN
EVALUATION OR FOR INFORMATION LOST DUE TO SUCH TECHNICAL FAILURES.

I understand the Overnight Weight LossAnti-Aging Inc.
DBA Overnight Weight Loss Platform makes available a specific set of services
and I may need to seek other resources for my other health needs. There is no
guarantee that I will be approved for treatment by a Provider. My Provider
reserves the right to deny care for any reason if, in the professional judgment
of my Provider, the provision of the services, including when provided via
telehealth is not medically or ethically appropriate. I understand that the
Providers, and not Overnight Weight Loss Anti-Aging Inc. DBA Overnight Weight
Loss or the Overnight Weight Loss, are responsible for the quality and
appropriateness of the care they render to me and make all decisions regarding
clinical care in their independent discretion without the influence of Overnight
Weight Loss Anti-Aging Inc. DBA Overnight Weight Loss or the Overnight
Weight Loss. I agree to only seek relief against the Provider for any
liabilities pertaining to medical or clinical issues arising as a direct result
of medical or clinical services accessed through Overnight Weight Loss
Anti-Aging Inc. DBA Overnight Weight Loss

I understand that by using the Overnight Weight Loss
Anti-Aging Inc. DBA Overnight Weight Loss Platform I am not always speaking or
messaging with my Provider in real-time, and there may be a delay before my
messages or information is reviewed. I understand that I must check the Overnight
Weight Loss Anti-Aging Inc. DBA Overnight Weight Loss Platform for messages
because this is the way that my Provider will communicate important information
to me. I understand that if I do not check the Overnight Weight Loss Anti-Aging
Inc. DBA Overnight Weight Loss Platform regularly, then my services may be
delayed.

I understand that I have the opportunity to discuss
the use of telehealth, including the Healthcare Services, with my Provider(s),
including the benefits and risks of such use and the alternatives to the use of
telehealth. I have the right to withdraw my consent to the use of telehealth in
the course of my care, without prejudice to any future care or treatment and
without risking the loss or withdrawal of any health benefits to which I am
entitled, but I understand that the Providers who provide Healthcare Services
via the Overnight Weight Loss Anti-Aging Inc. DBA Overnight Weight Loss
Platform do not offer in-person treatment.

I understand that I have access to my medical record
pertaining to the Healthcare Services of Providers utilizing the Overnight
Weight Loss Anti-Aging Inc. DBA Overnight Weight Loss Platform in accordance
with applicable laws and regulations and that my primary care provider, or
other treating provider, may obtain copies of my health and wellness
information with my consent.

I understand that while the Overnight Weight Loss
Anti-Aging Inc. DBA Overnight Weight Loss Platform may make available access to
pharmacy or diagnostic lab services that are coordinated with the Healthcare
Services, I am able to request any pharmacy or lab of my preference.

I agree that Overnight Weight Loss Anti-Aging Inc. DBA
Overnight Weight Loss is a third-party beneficiary of the Telehealth Patient
Consent and has the right to enforce it against you.