I, the undersigned patient (patient) hereby agree and expressly authorize LA Health & Rejuvenation to secure a medical laboratory, physician and dispensing office/pharmacy to provide my diagnostic testing, medical care and if indicated, prescribed pharmaceuticals based on my completed medical history form and any laboratory diagnostic tests obtained through LA Health & Rejuvenation. I understand that LA Health & Rejuvenation shall pay such physician as an independent contracting physician, to render my medical services from funds I pay to LA Health & Rejuvenation. I further understand and agree that the independent contracting physician, and not LA Health & Rejuvenation Inc., is rendering the medical care, services and treatment to me. LA Health & Rejuvenation Inc. is instructed and authorized to obtain the necessary medications prescribed by said medical doctor by causing them to be dispensed directly to me and/or sent to me by any pharmacy in the country of my residence. I specifically hold harmless and waive any and all claims or defenses against LA Health & Rejuvenation Inc. or the treating medical physician selected by LA Health & Rejuvenation Inc. I hold harmless and waive any and all claims or defenses against LA Health & Rejuvenation Inc., a licensed corporation, its directors, officers, shareholders, employees, agents, contractors, contracting physicians and contracting medical laboratories for any harm or injury I sustain from any act or omission of said treating medical doctor or other party. I also hold harmless and waive any and all claims or defenses against any treating and prescribing medical doctor selected by LA Health & Rejuvenation Inc. to render medical services for me for any harm or injury I sustain as a result of treatment rendered by said doctor. I also hold said treating physician harmless and waive any and all claims and defenses for injuries or illnesses I sustain as a result of my failure to comply with the method of treatment and dosage schedule prescribed by said doctor or from my failure to disclose all relevant facts to said doctor. I agree to immediately cease any medical treatment prescribed by said medical doctor in the event of any adverse response or side effect arising from prescribed treatment and provide immediate written notice to LA Health & Rejuvenation via phone 888-899-6888. I further agree to comply with prescribing instructions for use of medications.

I, the undersigned Patient, understand and acknowledge that the practice of medicine is not an exact science and that diagnosis and treatment may involve risks or injury. I acknowledge that no promises, assurances or guarantees have been made to me as to the results of diagnostic testing, analysis of test results, examination of medical history or treatment by LA Health & Rejuvenation or any treating or prescribing medical doctor provided to me by LA Health & Rejuvenation. I understand that the hormone blood level objective sought to result from my hormone replacement therapy, as prescribed by my treating medical doctor may be the highest level of standard reference range for my sex and age, or an even higher hormone blood level normally found in a person younger than myself. I understand that hormone replacement therapy for the purpose of elevating my hormone blood levels to the highest level of standard reference range for my age and sex, or above such range to the level of a younger person, is experimental and may not render any benefits, but may result in unknown adverse results.

I am aware of the nature, risk, possible alternative methods of treatment, possible consequences, and possible complications involved in my treatment. In understand that recombinant human growth hormone replacement for adults involves the use of a medical drug approved for one purpose for a new and different purpose in an effort to obtain sought objective of medical treatment. Nevertheless, I consent to such care and treatment, and I execute this form with complete informed understanding and for the purpose of authorizing the medical doctor obtained for me by LA Health & Rejuvenation Inc. to administer to me for the relief of my body ailments and to enhance my physical condition and health. I consent to receipt of foreign-related versions of any prescribed drug approved for medical use in the country of my residence. I understand that the methods of medical treatment offered or provided are not accompanied by any claims, guarantees or promises. I agree to present my photo identification at any time my blood is drawn pursuant to a LA Health & Rejuvenation Inc. test requisition.

I understand that medical information revealed by me may be used for continued medical research purposes, but that I will not be personally identified at any time. I understand that a prescribed drug ordered by me from LA Health & Rejuvenation may be dispensed to me by a pharmacy in my country.

I understand that LA Health & Rejuvenation Inc. and doctors obtained to provide medical treatment have elected not to carry malpractice insurance due to the unique and unconventional medical treatments designed primarily to be preventative and non-invasive. With respect to any Florida medical doctors rendering or prescribing my treatment at the request of LA Health & Rejuvenation Inc. this notice is provided pursuant to S.458 320 Florida Statute. I expressly agree that the jurisdiction and venue for any medical claim, legal or equitable claim or any type whatsoever, or any dispute regarding pharmaceuticals, physicians, physicians services, medical laboratories, or any services or products provided to me by LA Health & Rejuvenation its contracting pharmacies or any services rendered by any medical doctor it selects for me shall be exclusively by binding arbitration in Palm Beach County, Florida, USA. I consent to the transfer and removal of any claim or action brought by me against LA Health & Rejuvenation Inc., its physicians, contractors, medical laboratories, officers, directors, and share-holders to binding arbitration in Palm Beach County, Florida, USA. Further, I agree to pay all costs and reasonable attorney’s fees incurred by any party against whom I bring a claim or action in violation of the terms of this instrument or related to the transfer, removal, change of venue of any claim brought by my against any party to venue in Palm Beach County, Florida, USA as such costs are incurred on a weekly basis, without exception or assertion of any legal or equitable defense on my part or any legal counsel obtained to represent me. Jurisdiction and venue for any action brought against the Patient or its principal, by LA Health & Rejuvenation, its officers, directors, contracting physicians or laboratories is Palm Beach County, Florida, USA.

The pharmaceuticals and laboratories blood testing services supplied by LA Health & Rejuvenation, and medical services provided to me by treating medical doctors may or may not be covered or reimbursed by Medicare or other insurance. In any case, LA Health & Rejuvenation will not submit insurance claims on behalf of the patients.

In consideration of LA Health & Rejuvenation undertaking to render the undersigned patient any administrative or any other services in any way to this agreement, or LA Health & Rejuvenation disclosing information or methods of treatment to patient (either of which are deemed sufficient consideration for this agreement), then, in the event any court determines that the undersigned patient sought medical treatment or medical prescriptions through LA Health & Rejuvenation for possible or apparent purpose, directly or indirectly, of deception, assisting any investigation, or the rendering of any type of assistance to, or disclosing any information pertaining to LA Health & Rejuvenation, its procedures, officers, directors or medical protocols, to any news organization, possible or actual competitor, any type of governmental agency, any investigator or any other party for the possible or apparent purpose of securing any information, confidential or otherwise, about LA Health & Rejuvenation, it’s officers, directors, shareholders, affiliates, banking relationships, contractors, medical laboratories, contracting physicians, medical protocols, sources of pharmaceuticals, proprietary medical treatment protocols or LA Health & Rejuvenation’ system of pharmaceuticals procurement, distribution, and dispensing, then the undersigned Patient knowingly, expressly and irrevocably consents to a judgment in favor of LA Health & Rejuvenation, it’s officers or any party proceeding under the authority of this instrument, of liquidated damages, jointly and serially against the undersigned patient, as well as, any express or apparent principal of patient (including Patient’s employer) as an authorized or apparent agent of his principal or employer, in the amount of Ten Million Dollars, ($10,000,000.00), which liquidated damage amount is hereby accepted by the undersigned as a reasonable amount for engaging in any such acts or deception and because they are difficult to ascertain. The undersigned patient engaged in such deception or any of the above described acts, agrees on behalf of himself and his principal, to pay all reasonable attorneys’ fees costs incurred by any person or entity to enforce this agreement. This agreement represents the complete and entire agreement between the parties to it.