AXIOM IV HYDRATION THERAPY, INC. DBA AXIOM HEALTHSPAN
COMPREHENSIVE CONSENT FORM AND ARBITRATION AGREEMENT

This agreement applies to all services provided by Axiom IV Hydration Therapy, Inc. DBA Axiom Healthspan ("Axiom Healthspan"), including aesthetic treatments, IV hydration therapy, longevity medications, and weight loss programs. By signing this agreement, I acknowledge and consent to the terms, conditions, and potential risks associated with these services.

1. Acknowledgment of Services

I understand that I am receiving one or more of the following services from Axiom Healthspan:

Aesthetic Treatments: Botox, Juvederm, Versa, Dysport, or other injectable treatments.
IV Hydration Therapy: Administration of fluids, vitamins, minerals, and/or medications via intravenous, intramuscular, or subcutaneous routes.
Longevity Medications: Including NAD+ nasal spray and cream, hair restoration treatments, GHK-Cu scalp and facial solutions, and Sildenafil.
Weight Loss Medications: Including Semaglutide, Tirzepatide, Bella Capsules, and Lipo B.

I confirm that I have disclosed all known allergies, medical conditions, medications (including over-the-counter and recreational drugs), and supplements to the medical provider prior to receiving treatment. I acknowledge that failure to provide accurate information may increase the risk of complications, and Axiom Healthspan is not liable for any such complications arising from incomplete or inaccurate disclosure of my medical history.

2. Potential Risks and Side Effects

I acknowledge that each service carries inherent risks and side effects, including but not limited to:

Aesthetic Treatments:

Common: Swelling, bruising, tenderness, redness, or mild discomfort.
Less Common: Infection, allergic reaction, asymmetry, muscle weakness, drooping eyelids.
Rare: Anaphylaxis, scarring, nerve damage.

IV Hydration Therapy:

Common: Vein irritation, headache, fluid overload.
Rare: Phlebitis, metabolic disturbances, severe allergic reactions.

Longevity Medications:

Common: Skin irritation, headaches, mild nausea.
Less Common: Fatigue, dizziness, rare allergic reactions.
Serious: Cardiovascular events, severe allergic reactions.

Weight Loss Medications:

Common: Nausea, diarrhea, constipation, abdominal discomfort.
Less Common: Hypoglycemia, gallbladder disease, kidney injury.
Serious: Risk of thyroid C-cell tumors (Semaglutide/Tirzepatide), suicidal ideation.

I understand that individual results vary and that no guarantees are made regarding the outcome of any treatment. I am responsible for seeking and paying for any follow-up medical care due to adverse reactions.

3. Payment and Refund Policy

I acknowledge and agree to the following:

No Refund Policy: All sales are final. No refunds will be issued for treatments or shipped medications.
Prepayment Requirement: Full payment is required before the service or product is provided.
Telehealth Program Refunds: If I do not qualify for a medication program after a telehealth consultation, I will be refunded the product cost minus credit card processing fees. However, no refunds will be issued once medications have been shipped.

4. No-Show and Cancellation Policy

I understand and agree to the following:

Appointments cancelled less than 24 hours prior to appointment start time could be subject to a $50 charge.

5. Telehealth Services

I understand that certain services require telehealth consultations. I acknowledge that:

Telehealth consultations are not a substitute for emergency care.
These consultations may be recorded and stored for training and quality assurance in compliance with HIPAA.
Telehealth consent details are available at https://axiomhealthspan.com/telehealth-consent.

6. Consumer Privacy and Data Security

Axiom Healthspan complies with HIPAA and consumer health data privacy regulations. I acknowledge that:

My health data will be handled as per the privacy policy found at https://axiomhealthspan.com/privacy.
Information regarding consumer health data practices is available at https://axiomhealthspan.com/consumer-privacy.

7. Arbitration Agreement

I agree that any disputes, including but not limited to medical malpractice claims, shall be resolved through binding arbitration, and I waive my right to a trial by jury. Arbitration terms can be found at https://axiomhealthspan.com/terms.

Arbitration Procedures:

All disputes must be submitted in writing.
Both parties will select a mutually agreeable arbitrator.
Each party is responsible for its own legal fees, with arbitration costs split equally.
If any provision is deemed unenforceable, the remaining provisions remain in effect.

8. Acknowledgment and Consent

By signing below, I confirm that:

I have read and understand the risks, policies, and procedures outlined in this agreement.
I have been provided access to the Privacy Policy, Telehealth Consent Policy, and Terms of Use.
I am of legal age and sound mind to consent to the selected services.
I understand and agree to the no-refund and no-show policies.
I consent to receive SMS notifications and marketing communications from Axiom Healthspan, with the ability to opt out at any time.