The HealingPlaceSPRAVATO^TM

INFORMED MEDICAL CONSENT & AUTHORIZATION 1. NATURE OF SERVICES I acknowledge that RebornLyfe Luxury MedSpa ("RebornLyfe") provides physician-supervised medical wellness services including, but not limited to: intravenous (IV) vitamin and mineral infusion therapy, peptide protocols, hormone optimization therapy (testosterone replacement / bioidentical hormone therapy), medical weight management utilizing GLP-1/GIP receptor agonists (semaglutide, tirzepatide), NAD+ infusion therapy, B12 injection therapy, shockwave therapy, and related wellness treatments. These are medical procedures performed under physician oversight and carry inherent risks. 2. PHYSICIAN EVALUATION REQUIRED I understand that ALL medical services require a physician consultation and individual evaluation prior to treatment initiation or medication dispensing. RebornLyfe and its licensed providers reserve the right to decline, modify, or discontinue any treatment at any time based on medical judgment, safety concerns, or clinical findings. 3. DUTY TO DISCLOSE I agree to provide complete, accurate, and current information regarding my full medical history, all current and recent medications (including over-the-counter supplements and herbal products), known allergies and sensitivities, and all pre-existing diagnoses or health conditions. I understand that withholding or misrepresenting material health information may compromise my safety and may relieve RebornLyfe and its providers of liability for any resulting adverse outcomes. 4. ACKNOWLEDGED RISKS I understand that all medical procedures and pharmacological treatments carry potential risks including, but not limited to: allergic or anaphylactic reactions; pain, bruising, swelling, or infection at injection or infusion sites; nausea, dizziness, or lightheadedness; cardiovascular effects; hormonal fluctuations; changes in blood pressure or blood glucose; drug interactions; and other adverse outcomes that cannot always be anticipated. I consent to evaluation and treatment with a full understanding of these risks. 5. VOLUNTARY PARTICIPATION & RIGHT TO REFUSE My participation in any RebornLyfe treatment program is entirely voluntary. I may decline, pause, or discontinue any treatment at any time without penalty. I understand that discontinuing a prescribed medical protocol (e.g., a GLP-1 weight loss program or hormone therapy regimen) without physician guidance may adversely affect my health outcomes. 6. NO GUARANTEE OF RESULTS No guarantee of specific outcomes, results, weight loss targets, therapeutic benefits, or aesthetic improvements has been made to me. I understand that individual responses to treatment vary based on genetics, age, current health status, lifestyle, medication adherence, and other factors outside RebornLyfe's control. 7. AGE CONFIRMATION I confirm that I am at least 18 years of age and am legally competent to enter into this agreement and consent to medical treatment on my own behalf. 8. HIPAA AUTHORIZATION I authorize RebornLyfe Luxury MedSpa to use and disclose my protected health information (PHI) for the purposes of treatment, payment processing, and healthcare operations, as permitted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable Georgia state law. I acknowledge that I have been given the opportunity to review RebornLyfe's Notice of Privacy Practices. 9. COMMUNICATION AUTHORIZATION I authorize RebornLyfe to contact me via telephone, email, and/or text message (SMS) regarding appointment scheduling, treatment follow-up, program updates, and wellness-related communications. Standard carrier messaging rates may apply. 10. ELECTRONIC SIGNATURE & BINDING AGREEMENT I understand that checking the box below constitutes my legally binding electronic signature and informed consent, with the same legal force and effect as a handwritten signature, pursuant to the Electronic Signatures in Global and National Commerce Act (E-SIGN Act, 15 U.S.C. § 7001 et seq.) and the Georgia Electronic Records and Signatures Act (O.C.G.A. § 10-12-1 et seq.). I confirm that I have had a reasonable opportunity to read this consent, that I understand its terms, and that I agree to be bound by it.