Authorization and Release Form For The Anti-Aging Clinic Assoc., Inc. You must print, sign this form in the presence of a Notary and we must receive it by mail or in person, when you make this purchase below of our BHRT program, this means you agree with all the terms and conditions stated below.

Authorization and Release Form For The

Anti-Aging Clinic Assoc., Inc.

In consideration of instructions from Anti-Aging Clinic Assoc., Inc.,(AACAI) it’s associates and assigns, providing the undersigned (Client) with non- medical management, administrative and referral services, Client acknowledges and agrees to the following terms and conditions contained in this Client Authorization (AGREEMENT). With this agreement, Client submits an accurately completed Personal History Form (PHF). Client agrees to respond truthfully, accurately, --and completely in completing the PHF and acknowledges that failure to provide trthful, accurate, and complete information on the PHF, or to AACAI, or to the physicians selected by client or, if client desires, physician referred by AACAI, which could result in inappropriate treatment.

Client authorizes AACAI to obtain, on his/her behalf: medical laboratories, diagnostic testing, physicians and dispensing pharmacies information and any other necessary affiliate as deemed appropriate by AACAI. In addition; Patient authorizes and instructs AACAI to contact physician/s selected by Client or referred to Client by AACAI, as well as dispensing pharmacies, Pharmacist/s and any of the indemnified parties referred to herein, obtained on the behalf of the Client, to provide products, medical care and prescribed pharmaceuticals based on the patient’s PHF, laboratory diagnostic tests, and other information submitted to AACAI under this agreement. Client agrees to present photo identification upon any testing including blood and saliva pursuant to an AACAI, indemnified party, referred to herein or, Physician test requisition. Client acknowledges that therapies, laboratory and diagnostic testing services supplied or obtained by AACAI, and medical services provided to the client by Physicians, are not covered, may not be reimbursed, by Medicare or other insurance; and in all cases it is up to the Client to submit to these entities separate from AACAI or it’s indemnified parties.

Client acknowledges that AACAI ‘s employees and agents are not licensed Pharmacist/s, physician/s and that Physician/s and Pharmacist/s obtained on the behalf of the client by AACAI, are independent contractors, which will be compensated by Client separately from funds provided to AACAI. If any or all subcontractors are those suggested by AACAI there is no financial connection. Client acknowledges that AACAI does not practice medicine, and that AACAI is NOmedical and suggests natural substances and is the management, administration of referral service, and does not direct, control, or influence the treatment decisions made by any Physician or Pharmacist. You (the client) further understand and agree that AACAI is instructed and authorized to arrange for the prescribed pharmaceuticals to be dispensed and sent to you by any pharmacy in your country of residence. Patient covenants and agrees to comply with the method of provides that instructions, treatment and dosage for scheduled prescriptions that are prescribed by Physician/s and Pharmacist/s, to immediately cease any natural product, prescription or medical treatment prescribed by Physician/s, Pharmacist/s or as referred to herein, indemnified parties in the event of any adverse reaction or side effect. You further acknowledge and agree that AACAI is not liable for any negligent act or omission of any of the indemnified parties and assumes no liability for natural substances.

Client acknowledges that diagnosis and treatment may involve risk of injury, and that AAACI and Physician/s or as referred to herein, “indemnified parties”, have made no guarantees or warranties with respect to the above-described diagnostic testing, analysis

of the test results, examination of personal or medical history or hormone therapy. Client acknowledges that the hormone level objective sought as a result of Client hormone replacement therapy, as prescribed by a Physician, may be at the highest level of standard reference range for Client’s age and sex, or, in some cases, above such range to the level of a younger person, and that such range is experimental and may not render any benefits, but may result in unknown, adverse results. Client is aware of the nature, risk, and possible alternative methods of treatment, possible consequences, and possible complications involved in such hormone replacement treatment. Client acknowledges that bioidentical hormone replacement therapy or recombinant human growth hormone therapy can involve, the use of a medical drug approved for one purpose, for a new and different purpose in an effort to obtain a desired objective of medical or cosmetic treatment. Nonetheless, Client consents to such care and treatment, and executes this AGREEMENT with a complete, informed understanding of such hormone replacement therapy for the purpose of authorizing Physician/s and indemnified parties to administer such treatment in an attempt to relieve body ailments and attempt to enhance Client’s physical condition and health. Client further acknowledges that the methods of natural or medical treatment offered by AACAI, and Physician/s and or indemnified parties, are not accompanied by any claims, guarantees, promises or warranties.

Client is freely seeking consultation in person or via the Internet or, from AACAI offices, officers or its affiliates, and acknowledges and consents to AACAI’s Physician/s, Pharmacies, Pharmacist’s or AACAI’s affiliates reviewing Patients medical history without having the opportunity to conduct an in-person physical examination. Where some states may not allow a prescription without an in-person physical examination, the transaction may not occur and Client agrees it is his/her responsibility to become aware of laws in their state and decline the services of AACAI or its physician/s, staff, officers, affiliates or assign’s.  Client solicits AACAI for a specific natural substances or prescription medication designed by AACI’s indemnified parties to treat an already identified medical or cosmetic condition. Client acknowledges that AACAI’s Physician/s may not be licensed to practice medicine in Client’s state or country of residence. Further, Client agrees that AACAI’s Physician/s, Pharmacist/s or AACAI’s affiliates consultation, diagnoses, and treatments will be deemed to have occurred and will have occurred before shipment of any product or prescription in Florida, where physician/s is/are licensed to practice medicine.

Client represents that he or she is under the care of THEIR primary care physician and that Physician will not rely or substitute the advice of AACAI’s Physician/s should it conflict with the advise given to Client by Client’s primary care physician. Before taking any natural substance from AACAI or medication prescribed by AACAI’s physician/s, Client agrees to have a comprehensive physical examination by his or her primary care physician. Client agrees to notify his or her primary care physician and advise such physician that Client is undergoing Bioidentical hormone replacement therapy and or natural substance/s suggested by AACAI.

Client acknowledges that under Florida law physicians are generally required to carry medical malpractice insurance or otherwise demonstrate financial responsibility to cover potential claims for medical malpractice. PHYSICIAN/s HAS/HAVE DECIDED NOT TO CARRY MEDICAL MALPRACTICE INSURANCE. This is permitted under Florida law, under certain conditions. Florida law imposes penalties against noninsured physicians who fail to satisfy adverse judgments arising from claims of medical malpractice. This notice is provided pursuant to Florida law. AACAI carries no insurance or declares no warranties for any suggested natural substance AACAI suggests or, any substance that AACAI’s indemnified parties suggest or prescribe.

Client acknowledges and agrees that AACAI is not responsible for the negligent or intentional acts or omissions of any health care provider or subcontractor or indemnified party that Client is referred to or, for any action or inaction taken by Client, and that the total liability of AACAI, its officers, directors, employees, agents, assigns and stockholders is limited to the purchase price of any product purchase directly from AACAI not those purchased from AACAI’s indemnified parties. AACI and or AACAI Physicians, or pharmacies, which are referred to as indemnified parties herein, will not be liable for any direct, indirect, special, incidental, consequential, or punitive damages or costs of any nature outside the limit of purchase price of any said product. During Client’s relationship with AACAI and its Physician/s and/or indemnified parties; AACAI and Physician/s and indemnified partiers, will convey to Client a range of proprietary business information, including, confidential disclosures and trade secrets, business practices, and AACAI customers and suppliers (Confidential Information). No matter how received by Client, during the parties relationship, Client agrees that confidential information is confidential, proprietary and uniquely valuable to AACAI and gravely affects the conduct of business of AACAI, and AACAI’s goodwill. Client agrees not to disclose, divulge, or communicate, in any fashion, form, or manner, either directly or indirectly, any of the confidential information to any third party person, firm, or business. Client agrees that if the terms of this paragraph are breached, AACAI shall be conclusively deemed to be irreparably injured and shall be entitled to an injunction restraining Client from disclosing any of the Confidential Information and to liquidated damages in the amount of Ten Million Dollars ($10,000,000.00). Client agrees that the amount of AACAI’s actual damages in such circumstances would be difficult, if not impossible, to determine with accuracy, but would be substantial in any event, and Client agrees that such liquidated damages are not a penalty.

Based on your signature where applicable of your understanding and agreement of this complete agreement, Client agrees to release AACAI, its officers, directors, employees, agents, assigns and shareholders, and Physicians and pharmacies and Pharmacists (referred to as indemnified parties) from any and all liability associated with or, arising from, the indemnified parties consultation, products, or from the personal and or medical, physical, behavioral or other effects of any product or medication or treatment that may  

be ordered, prescribed or purchased as a result of the indemnified parties or his/her representatives.

This agreement shall be governed and enforced with the laws of the State of Florida, applicable to agreements made and to be performed entirely within such State, without regard to principles of conflict of laws. Any disputes arising out of, in connection with or with respect to this Agreement, shall be adjudicated in a court of competent jurisdiction sitting “Fort Lauderdale/Broward County” and nowhere else. Client hereby irrevocably submits to the jurisdiction of such court for the purposes on any suit, civil action or other proceeding arising out of, in connection with or respect to this Agreement. In the event of any litigation arising out of this Agreement, the prevailing party shall be entitled to recover all expenses and costs incurred, including reasonable attorneys fees and legal assistants fees.

This Agreement contains the entire understanding of the parties and supersedes and merges all prior and contemporaneous agreements and discussions between the parties. Any and all representations or agreements by any agent or representative of either party not contained in this Agreement shall be null, void and of no effect.

If any provision of this Agreement or the application thereof, to any person or circumstances is held invalid or unenforceable, in any jurisdiction, the remainder hereof, and the application of such provision to such person or circumstances in any other jurisdiction, shall not be affected thereby, and to this end the provisions of this Agreement shall be severable.

Client covenants and agrees to indemnify, defend, protect, and hold harmless AACAI and its Physicians, Pharmacists and their representatives, respective officers, directors, employees, subcontractors, stockholders, assigns, successors, and affiliates, (Indemnified Parties) from, against and in respect of; all liabilities, losses, claims, damages, punitive damages, causes of action, lawsuits, administrative proceedings, investigations, demands, judgments, settlement payments, deficiencies, penalties, fines, interest and costs and expenses suffered, sustained, incurred, or paid by the Indemnified Parties in connection with, resulting from, or arising out of, directly or indirectly, AACAI and/or its Physicians rendering, any substance suggestions, medical care, services, advise, and/or treatment, Client’s failure to disclose any or all relevant information regarding Client’s medical, personal and physical condition, acts or omissions of AACAI, its associates, affiliates, assigns or Physicians or Pharmacists, harm or injury resulting from any products, from any medical care or any pharmaceuticals provided directly or indirectly by AACAI, its Pharmacy, Pharmacists or Physicians. Client asserts he/she has made his/her family doctor aware of his/her choices to elect AACAI and AACAI’s indemnified parties suggestions of any and all products and prescriptions and that his/her family doctor does not object. Client is aware if potential side effects associated with the above-described products or treatments appear, Client accepts all risks involved in taking products or medications or treatments and will not seek indemnification or damages from AACAI or the AACAI Indemnified Parties there from. 

I am the client or client's guardian and I am aware of the preceding; I hereby agree with all stated in each paragraph and knowingly and voluntarily acknowledge and consent to all of the above-described statements provided by the Anti-Aging Clinic Assoc., Inc, as the client and or the legal guardian of the Client.

_________________________________________________            _______________________
Client signature                                                                                             Date

________________________________________________              _______________________
The legal guardian of the Client                                                                    Date

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Witness signature/s                                                                                       Date

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