The purpose of this notice is to provide information to, and obtaininformed consent (“Consent”) from, clients seeking and receiving wellnessservices from LainaHealth, Inc. (“LainaHealth”). Please note that this consentmay be withdrawn at any time by notice in writing to LainaHealth. Please readand indicate that you have reviewed this information and agree to it by fillingin the checkbox at the end of this document.

None of the LainaHealth practitioners who provide wellness services arelicensed physicians and none of them are providing services to you as alicensed physical therapist or other licensed professional. Further, thewellness services provided are not licensed services.

By indicating your acceptance below, you acknowledge that LainaHealthcannot give you a medical diagnosis or provide physical therapy services. Thewellness services provided by LainaHealth are not a substitute for a medicaldiagnosis by a physician or medical or physical therapy services. As part ofthis Consent, you agree to provide your LainaHealth practitioner with accurateand complete information as relevant to the wellness services you receive.

By indicating your acceptance below, you acknowledge that due to thenature of digital wellness services, you may be limited in the availability ofsome of the above services. Your LainaHealth practitioner will thoroughlyexplain to these limitations before services are performed.

By indicating your acceptance below, you acknowledge that a remotewellness consultation and/or services will not be the same as an in-personmeeting due to the fact that you will not be in the same room as yourpractitioner and, as a result, such services may carry certain risks.

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Risks, Benefits and Alternatives

By agreeing to these terms, you acknowledge that you understand thatthere are risks and benefits to digital wellness services.  The benefitsof digital wellness include the ability to efficiently access services fromhome or other location. Potential risks of the LainaHealth digital wellnessplatform include:

• inability to conduct hands-on examination and treatment,
• technical problems such as  unclear video, loss of sound, or connection interruption that may require  a session to be rescheduled or require a follow-up face-to-face  consultation,
• in rare circumstances, security measures could fail causing a potential breach of personal medical information, or
• limited ability to respond to emergencies.

Your LainaHealth practitioner, may discontinue or reschedule a digitalwellness consultation if the video quality or audio connection is not adequatefor the situation. You agree to not hold LainaHealth responsible for lostinformation due to technological failures.

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Confidentiality

The session content and all relevant materials will be held confidentialunless you request in writing to have all or portions of such content releasedto a specifically named person/persons or unless disclosure to a third party isotherwise permitted or required by applicable law.

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Digital Wellness

Digital wellness involves the use of audio, video, or other electroniccommunication to enable a practitioner to interact with a client and provideservices from a remote location. Audio-conferencing and/or video-conferencingtechnology will be used to facilitate the digital wellness session between apractitioner and client located in two different locations. The session may berecorded for quality review, operations, training, research, and safetypurposes in accordance with applicable law.

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Records

LainaHealth will maintain records of the wellness services provided toyou.  You are entitled to receive a copy of your records, or LainaHealthcan prepare a summary for you instead. Clients may be charged an appropriatefee for any practitioner time spent in responding to information requests.

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Consent for Email Communication

Confidential and secure communication with LainaHealth practitioners cantake place through the Secure Messaging feature in the Client Portal.However, if you wish to contact your team for basic communication purposes orto schedule appointments (all of which can also be done in the Client Portal),clients may call or email LainaHealth directly. If clients choose to email,please note that it is not a secure means of communicating and the privacy ofemail communications cannot be guaranteed.

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Consent for Video Recording

LainaHealth is requesting your permission to record individual and groupsession(s) via HIPAA-compliant video recordings. This allows us to provide anadditional level of supervision, as we are working to provide you the highestquality services. No recording will be done without your prior knowledge andconsent. Viewers of the video file(s) and this documentation may includesupervisors, staff, and professional colleagues, but shall not be available toany third-party outside of LainaHealth, unless such third-party is subject toappropriate confidentiality obligations.