Telehealth & Clinical Services Consent

BY CLICKING “I AGREE,” CHECKING A RELATED BOX, OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT THROUGH THE ALUNA PLATFORM, YOU ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND AGREED TO THE TERMS OF THIS TELEHEALTH AND CLINICAL SERVICES CONSENT. IF YOU DO NOT AGREE TO THIS CONSENT, DO NOT PROCEED WITH CREATING AN ACCOUNT OR ACCESSING CLINICAL SERVICES THROUGH THE PLATFORM.

You understand and agree to the following regarding your use of a telehealth consultation with the Practice pursuant to these terms:

• Establishment of Relationship: You understand that a practitioner-patient relationship will be established between you and a Provider affiliated with the Practice. Your Provider will be responsible for your medical care.
• Nature of Telehealth: You understand that your evaluation and treatment will be conducted remotely via electronic communication, which may include asynchronous (store-and-forward) messaging in which your Provider reviews your submitted information and responds at a later time without a live, real-time interaction. Consultations may also occur via video or audio. You understand that asynchronous consultations do not allow for real-time dialogue, follow-up questions during the encounter, or a physical examination, and that these limitations may affect your Provider’s ability to diagnose or treat certain conditions. You understand that telehealth is not a substitute for an in-person physical examination and that your Provider may determine that an in-person visit or synchronous consultation is necessary.
• Right to Refuse Telehealth: You understand that your consent to receive care via telehealth is voluntary. You may withdraw your consent at any time. Withdrawing your consent will not affect your eligibility for future care, but because the Practice delivers services exclusively through telehealth, withdrawal may limit or prevent the Practice’s ability to continue providing services to you through the Aluna platform.
• Patient Location: You understand that you must be physically located in a state where your Provider is licensed at the time of each consultation. You agree to accurately disclose your physical location at the time of each consultation and understand that providing inaccurate location information may affect the validity of your consultation and any prescriptions issued.
• Provider Information: You understand that your Provider is a licensed medical practitioner credentialed through the Practice. Information about your Provider’s licensure, qualifications, and the state(s) in which they are licensed to practice will be made available to you upon request and before your consultation begins.
• Technology and Privacy: You understand that the telehealth platform requires a device with internet access. You understand that electronic communications carry inherent risks to privacy and security, including the possibility of technical failures, unauthorized access, or data breaches, despite reasonable safeguards. You accept these risks and agree to conduct your consultations in a private setting.
• AI Technologies: You understand that the Practice and Aluna use artificial intelligence (“AI”) technologies as part of the delivery of your care. This includes AI-assisted recording and transcription of your scheduling interactions and clinical consultations, analysis of your health information to generate clinical insights and assist with clinical decision-making, medical coding and billing, and processing by third-party AI providers, including Anthropic/Claude. All AI processing of your health information is subject to the privacy protections described in Aluna’s Notice of Patient Privacy Practices. You may request that your health information not be processed using AI technologies by notifying your Provider or contacting Aluna at support@alunascience.com. Because AI technologies are integrated into the platform’s clinical and administrative operations, opting out may limit or prevent the Practice’s ability to provide services to you through the Aluna platform.
• Reliance on Information: You understand that your Provider must rely on the health information, medical history, and images you provide. You agree to provide complete and accurate information. You understand that the omission or misrepresentation of information could result in a failure to diagnose a condition or could lead to adverse effects from your treatment.
• Response Times: You understand that for asynchronous consultations, your Provider will review your submitted information and respond within the timeframe communicated by the platform. You understand that response times are not guaranteed and may vary based on clinical complexity and Provider availability.
• Notification of Changes: You agree to promptly notify your Provider of any changes that may affect your eligibility for or the safety of your treatment, including but not limited to: pregnancy or plans to become pregnant, breastfeeding, new medical diagnoses, hospitalizations, surgeries, changes in other medications or supplements, and any other condition that may conflict with your prescribed treatment.
• Coordination with Other Providers: You are encouraged to inform your primary care provider and any other treating healthcare professionals about any treatment you receive through the Aluna platform. You understand that the Practice and Aluna are not responsible for adverse interactions with treatments prescribed by other providers that you fail to disclose.
• Primary Care: You understand that the telehealth services provided through the Aluna platform are supplemental to, and not a substitute for, an ongoing relationship with a primary care provider. You are encouraged to maintain a primary care relationship for your comprehensive healthcare needs.
• Emergency Procedures: You understand that the telehealth platform is not intended for medical emergencies. In the event of a medical emergency, you will call 911 or seek immediate in-person medical attention.

You acknowledge, understand, and consent to treatment with peptide compounds and other medications, if prescribed, and you agree to the following:

• FDA Disclosure: You understand that the peptides and other medications prescribed to you may be compounded medications that are not FDA-approved, or in some cases, may be FDA-approved medications used in a compounded form or for purposes consistent with their approval. For those peptides and other medications that are compounded and not FDA-approved, you understand that the FDA has not evaluated them for safety, effectiveness, or quality before they are marketed. You understand that compounded medications are not generic drugs, are not interchangeable with any FDA-approved product, and should not be considered equivalent in safety, efficacy, or quality to any branded or FDA-approved medication. You understand that compounded medications should only be used when your Provider determines that your medical needs cannot be met by an FDA-approved drug. You acknowledge that there may be limited data on the long-term safety and efficacy of compounded peptides and other medications. You further understand that compounded medications carry risks distinct from FDA-approved drugs, including potential variability in potency, purity, and quality, and the possibility of contamination or sterility failures during the compounding process.
• Drug Interactions and Medical History Disclosure: Peptide therapy and other medications may interact with prescription medications, over-the-counter drugs, supplements, herbal remedies, recreational drugs, or existing medical conditions in ways that could affect treatment safety or efficacy. You understand that you must disclose all medications, supplements, vitamins, herbal products, recreational drug use (past or current), and medical conditions so that your Provider can try to manage drug interactions and side effects. This includes but is not limited to blood thinners, diabetes medications, hormone therapies, steroids, immune system medications, and any supplements affecting blood sugar, blood pressure, or hormone levels.
• Third-Party Compounding Pharmacy Disclosure: You understand that if your Provider prescribes peptide therapy or other medications, the prescription will be sent to and filled by a licensed compounding pharmacy. You understand that these pharmacies specialize in compounding medications, which are created for an individual patient and are not manufactured in bulk or approved by the FDA. You acknowledge and understand that the default compounding pharmacy used by the platform is owned by or affiliated with Aluna’s parent corporation. This financial relationship is disclosed so that you may make an informed decision about where to fill your prescription. Notwithstanding this affiliation, the Practice and its Providers exercise independent medical judgment in all prescribing decisions, and clinical decisions are not directed or controlled by Aluna or any affiliated pharmacy. The Practice is not responsible for the pharmacy’s acts or omissions, including but not limited to the compounding process, labeling, shipping, or any errors made by the pharmacy.
• Insurance and Cost: You understand that compounded medications are generally not covered by health insurance and that you will be responsible for the full cost of the medication ordered through Aluna. You understand that pricing for compounded medications may differ from pricing for FDA-approved alternatives. You acknowledge and agree that the Practice and Aluna are not enrolled with, and are not participating providers with, Medicare, Medicaid, or any other federal or state healthcare program or commercial insurance plan for the services provided through the platform. You agree that you are solely responsible for all costs associated with the services and products you receive through the platform and that neither you nor the Practice nor Aluna will submit a claim for reimbursement to any federal or state healthcare program or commercial insurer for such services or products.
• Financial Disclosure: You understand that the pricing offered through the Aluna platform is a bundled fee that includes both the consultation and the cost of medication dispensed by an Aluna-affiliated pharmacy. If you choose to fill your prescription at a non-affiliated pharmacy, the bundled pricing will not apply, the cost of the medication will not be included in your platform fees, and you will be solely responsible for any charges imposed by the non-affiliated pharmacy. Any platform-related discounts, promotions, or bundled pricing apply only to prescriptions filled through an Aluna-affiliated pharmacy. You have the right to have your prescription sent to any licensed pharmacy of your choice that is capable of compounding your prescribed medication, and you are under no obligation to use the default pharmacy. If you wish to designate an alternative pharmacy, you may notify your Provider or contact Aluna customer support.
• Dosing: You understand that compounded medications may have variability in concentration compared to FDA-approved drug products. You agree to follow the dosing instructions provided by your Provider exactly as prescribed and to not adjust your dosage, frequency, or method of administration without prior authorization from your Provider.
• Shipping and Delivery: You understand that compounded medications may be shipped to you via mail or courier and are subject to risks during transit, including delays, temperature exposure, and damage. You agree to inspect all packaging upon receipt and to contact the dispensing pharmacy promptly if the packaging appears damaged, unsealed, or if cold chain indicators suggest temperature compromise. You understand that neither the Practice nor Aluna is responsible for medication degradation, loss, or damage that occurs during shipping or after delivery.
• Self-Administration and Storage: You understand that if your prescribed peptide or other medication is an injectable medication, you will be responsible for self-administering the medication at home. You acknowledge the risks associated with self-injection, including but not limited to infection at the injection site, improper injection technique, bruising, and needle stick injuries. You agree to follow all administration and storage instructions provided by your Provider and the dispensing pharmacy, including any refrigeration or temperature requirements. You understand that failure to properly store or handle your medication may affect its potency, sterility, or safety, and that neither the Practice nor Aluna shall be liable for any adverse effects resulting from improper storage or administration by you.
• Alternative Treatments: You confirm that your Provider has discussed the risks, benefits, and alternatives to peptide therapy with you, including whether any FDA-approved medications are available to treat your condition and why a compounded medication has been recommended. You have had the opportunity to ask questions about your condition, the proposed treatment, any FDA-approved alternatives, and any other treatment options available.
• No Guarantees: You understand that the Practice and its Providers make no representations, warranties, or guarantees as to the efficacy, safety, or outcome of peptide therapy. You understand that results are not guaranteed and may vary.
• Adverse Event Reporting: You understand that you should report any adverse reactions or side effects to your Provider promptly. You may also report adverse events directly to the FDA through MedWatch at www.fda.gov/medwatch or by calling 1-800-FDA-1088.

You consent to receive communications from the Practice and Aluna by electronic means, including but not limited to email, text message (SMS/MMS), push notifications, and in-platform messaging. These communications may contain information related to your account, appointments, treatment, prescriptions, billing, and general health and wellness information.

You understand and acknowledge that standard email and text messaging are not encrypted or otherwise secured, and that communications sent via these channels may be intercepted, misdirected, or accessed by unauthorized third parties. Despite these risks, you consent to the use of unencrypted email and text messaging for communications related to your care, including responses to inquiries you initiate via these channels. You agree that the Practice and Aluna shall not be liable for any unauthorized access to, or disclosure of, your information that results from the use of unencrypted electronic communications that you have authorized under this section.

You may withdraw your consent to receive electronic communications at any time by contacting Aluna customer support or by updating your communication preferences in your account settings. Withdrawal of consent to electronic communications will not affect your ability to receive clinical services through the platform, though it may limit the methods by which the Practice and Aluna can communicate with you regarding your care. You understand that certain transactional or legally required communications (such as prescription notifications or safety alerts) may continue to be sent electronically regardless of your general communication preferences.

You are responsible for providing and maintaining a current, valid email address and phone number in your account. You agree to promptly update your contact information if it changes. The Practice and Aluna are not responsible for communications sent to outdated contact information that you have failed to update.

You understand that you have the right to request a copy of your medical records maintained by the Practice in connection with services provided through the Aluna platform. Medical records will be maintained and made available in accordance with applicable state and federal law. For further information on your rights related to your medical records and patient privacy, please see Aluna’s Notice of Patient Privacy Practices.

You voluntarily assume all known and potential risks associated with telehealth services and peptide therapy, including but not limited to:

• Known and unknown side effects, adverse reactions, or health complications from the treatment.
• Risks associated with the lack of long-term clinical studies for certain peptides and other medications.
• Risks arising from the limitations of a telehealth-based diagnosis and treatment.
• Risks specific to compounded medications, including potential variability in potency, purity, quality, or sterility that may differ from FDA-approved drug products.

You agree that you remain bound by all existing contractual obligations. By accepting this consent form, you acknowledge that you continue to be bound by all prior agreements with Aluna and/or the Practice, including Aluna’s Terms of Service and Privacy Policy. Without limiting the foregoing, you acknowledge that your use of the services and any products prescribed through the Practice remains subject to the limitation of liability and disclaimer of warranties provisions set forth in the Terms of Service, to the fullest extent permitted by applicable law.

If you have concerns about the care you received from a Provider through the Aluna platform, you may contact the medical board or applicable licensing authority in your state. A directory of state medical boards is available at www.fsmb.org/contact-a-state-medical-board.

You acknowledge that your state of residence may have specific laws regarding telehealth, informed consent, and consumer health data. You agree to execute any state-specific addenda or consent forms as required by the Practice to comply with applicable law. You agree that this consent shall be governed by the laws of the state in which you reside. For information about your rights regarding your health-related data under applicable state privacy laws, including the right to withdraw consent to the processing of sensitive data, please refer to Aluna’s Privacy Policy.

You understand that the availability of compounded medications and telehealth services may change due to federal or state regulatory actions, including FDA determinations regarding drug shortages, compounding restrictions, or changes in telehealth prescribing rules. You acknowledge that the Practice and Aluna reserve the right to modify, suspend, or discontinue any treatment program in response to changes in applicable law or regulation, without liability to you. In the event of such a change, the Practice will make reasonable efforts to notify you and, where clinically appropriate, assist in transitioning your care.