Consent, Disclosures & Release

Please read carefully. Your signature and agreement below apply to every section.

1 · IV / Hydration Therapy

I confirm I have told my provider of all known allergies, current medications, and supplements. IV therapy is an elective wellness service, not a substitute for my physician's care, and is not intended to diagnose, treat, cure, or prevent any disease. The procedure involves inserting a needle into a vein to infuse a prescribed solution. Risks: commonly mild discomfort or bruising; rarely inflammation of the vein; very rarely severe allergic reaction, anaphylaxis, infection, or other serious complications. I have had the opportunity to be informed of the procedure, benefits, alternatives (including no treatment), and risks, and to ask questions.

2 · Regenerative Cellular Therapy (Allografts, Exosomes & Secretomes)

I understand I may receive a regenerative cellular product — an allograft, exosome, or secretome — that is US-derived and ethically sourced from FDA-registered, CLIA-certified labs, administered by intramuscular, intra-articular (joint), or intravenous route. These are NOT “stem cells” and NOT a drug. They are provided as an elective wellness service to support the body's own repair signaling and are not intended to diagnose, treat, cure, or prevent any disease. No guarantees or promises of results have been made to me; individual results vary. Possible risks include injection-site pain, swelling, or bruising; infection or bleeding; allergic reaction; temporary worsening of symptoms; and unforeseen or unknown complications. I understand alternatives exist, that participation is voluntary, and that I will follow after-care instructions (including avoiding anti-inflammatory medications as directed) and promptly report excessive swelling, difficulty swallowing, or fever.

3 · Release of Liability & Assumption of Risk

I am choosing these elective wellness services voluntarily and I assume the risks described above. To the fullest extent permitted by law, I release and hold harmless New Hope Vitality, its owners, providers, staff, and affiliated personnel from any and all liability, claims, or causes of action for any injury, loss, or damage arising from these services — except in cases of gross negligence or intentional misconduct. I understand no outcome is guaranteed and that these services do not replace care from my primary physician.

4 · Disclosures & Financial Acknowledgment

Services are elective and self-pay; I am financially responsible for services I receive (financing via Cherry & Affirm may be available). New Hope Vitality does not diagnose, treat, cure, or prevent disease and encourages me to maintain a relationship with my primary care provider.

5 · HIPAA / Notice of Privacy Practices

I acknowledge that I have been offered New Hope Vitality's Notice of Privacy Practices, describing how my health information may be used and disclosed for treatment, payment, and healthcare operations, and my rights regarding my information.

6 · Communications

By agreeing and signing below, I authorize New Hope Vitality (and its authorized partners) to contact me at the phone number and email I provide — for appointment verification, clinic needs, and marketing — by live agent or AI/artificial, automated & prerecorded voice calls, SMS/text messages, and emails. Consent is not a condition of purchase; message frequency varies; msg & data rates may apply; reply STOP to opt out, HELP for help.

By checking the box below and signing, I certify that the information I have provided is accurate, and that I have read, understand, and voluntarily agree to all of the consents, disclosures, and releases above.