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MEDICAL CONSENTS & DISCLOSURES

Your Body Deserves Premium Fuel

The following consent and disclosure documents apply to healthcare services coordinated through Evolve Your Bod. The specific documents you will be asked to review and sign depend on your care model. If you have questions about any of these documents, please contact us at info@evolveyourbod.com or 866-301-3141.

Clinical Consents

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Telehealth Informed Consent

Risks, benefits, and limitations of receiving care through telehealth. Required before your first telehealth consultation. Also applies to the telehealth component of Hybrid encounters.

Applies to: Telehealth, Hybrid

evolveyourbod.com/consents/telehealth/

IPV

In-Person Treatment Consent

Consent for receiving care at a partner clinic location. Identifies the rendering provider and partner clinic, and explains your rights during in-person visits.

Applies to: In-Person Visits

evolveyourbod.com/consents/in-person/

IV

IV Therapy Treatment Consent

Risks and potential complications of IV therapy, physician order chain, nurse administration responsibilities, adverse reaction protocols, and emergency escalation procedures.

Applies to: Hybrid + IV, Mobile IV

evolveyourbod.com/consents/iv-therapy/

Care Model Disclosures

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Hybrid Satellite-Site Facilitation Disclosure

Explains the three-party care arrangement before your Hybrid visit: Evolve Your Bod (technology platform), on-site nurse (facilitator), and remote physician (treating clinician). Includes information about how your data flows between all three parties.

Applies to: Hybrid

evolveyourbod.com/consents/hybrid-disclosure/

MV

Mobile IV Service Disclosure and Consent

In-home IV therapy service scope, nurse responsibilities, location safety assessment requirements, physician order authority, emergency escalation protocols, and state licensure disclosures.

Applies to: Mobile IV

evolveyourbod.com/consents/mobile-iv/

Privacy & Data Authorizations

PHI

PHI / Data-Sharing Authorization

Your consent for Evolve Your Bod to share your health information with the medical groups, partner clinics, pharmacies, laboratories, satellite site staff, and mobile nurses involved in your care. Includes a detailed breakdown of who receives your data under each care model.

Applies to: All care models

evolveyourbod.com/phi-authorization/

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Financial Responsibility Disclosure

Explains who bills you (Evolve, the partner clinic, or the rendering medical group), whether insurance applies to your care model, and your payment obligations before services are rendered.

Applies to: All care models

evolveyourbod.com/financial-responsibility/

Note: These documents are provided for your review and transparency. During the intake process, you will be presented with the specific consents and disclosures applicable to your care model and asked to sign or electronically accept them before services begin. You are not required to sign all documents listed here — only those that apply to the services you are receiving.

Additional Legal & Privacy Documents

The following documents are also available for your review:

Terms of ServiceThe foundational agreement governing your use of the Evolve platform across all care models.

evolveyourbod.com/terms-of-service/

Privacy PolicyHow we collect, use, store, and share your personal information as a technology platform.

evolveyourbod.com/privacy-policy/

Notice of Privacy PracticesHow your Protected Health Information (PHI) is used and disclosed under HIPAA.

evolveyourbod.com/notice-of-privacy-practices/

HIPAA ComplianceHow Evolve Your Bod protects your health information and the safeguards we have in place.

evolveyourbod.com/hipaa-compliance/

Important Safety InformationSafety data for medications, IV therapy, and peptide therapy services.

evolveyourbod.com/important-safety-medication-information/

Patient Bill of RightsYour rights as an Evolve Your Bod patient across all care models.

evolveyourbod.com/bill-of-rights/

Returns, Refunds & CancellationsOur policies for returns, refunds, cancellations, and billing disputes.

evolveyourbod.com/returns-and-refunds/

California Privacy Notice (CCPA)Additional privacy rights for California residents.

evolveyourbod.com/california-consumer-privacy-act-ccpa-privacy-notice/

Questions?

If you have questions about any of these documents, your rights, or your care model, we’re here to help.

Email: info@evolveyourbod.com

Phone: 866-301-3141

Address: 5521 Bellaire Drive South, Suite 200, Fort Worth, TX 76109