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CLUB HEAL INFORMED CONSENT & RELEASE OF CLAIMS

In connection with the undersigned’s participation in any of the HEAL Transformation System, LLC, dba, CLUB HEAL (“CH”), Circuit Healing Stations, (defined below), Brain Therapy or other device rental, (defined below), or Private Room Add-on Sessions, or other procedure offered/administered by CH, including any of its employees, agents, contractors or other service providers (collectively, “CH”), the undersigned hereby agrees to the consents and releases contained herein. The consents and releases contained herein also apply to any vitamins, nutritional supplements or other products you purchase from CH, including without limitation, any aesthetic, topical, facial/skin products.

Informed Consent

CLUB HEAL CIRCUIT HEALING STATIONS 

You have voluntarily elected to receive treatment from the healing devices and equipment at CH. In order for you to receive treatment from one or several healing stations, you will need to follow instructions given to you prior to or during use of each station. As directed by you, the following healing devices and equipment may be included in your recommended/chosen healing protocol; Spinalator Back Massager, T Zone Vibration Plate, Bellicon German Rebounder, Exercise with Oxygen Therapy (EWOT) 16 liters 02, Pulse Oximetry, Biofeedback and/or NLS Testing, Oligo Scan Heavy Metal Testing, Nitric Oxide Saliva Testing, Urine Toxicity, Blood typing test Ondamed (PEMF), Brain Training w Neuroptimal Zengar, Ozone Sauna and Tesla Healing Lights. 

CLUB HEAL PRIVATE ROOM ADD-ON’s  

A) Signature Transformation Sessions, including the following: Zerona 5 head red, cold laser with medical or fat melting frequencies, Laser Energetic Detox, Collagen Stem Cell/O2 facial w Electric Stim Face Lift, Arkturas Star Vibrational Lymphatic Therapy, Manual Massage w Cupping and or Essential Oil application

B) Ozone Insufflation (ear, pelvic floor and systemic), Detox Ozone Facial and Wound Cupping

C) Full body vibrational lymphatic therapy with Lymphapress Pants; CH may from time to time add healing equipment and/or testing modalities or products, and I understand those are included under this blanket consent and release form.

The risks associated with your participation with CH’s Circuit Stations and Private Session Therapies and Add-On’s, include, but are not limited to, the following: Natural movement of vertebrae using Spinalator Massage Table, Pain or discomfort, soreness or temporary bruising from cupping procedure, Inch loss and toning of muscles, shaking of body and brain using Vibroplate, Increased heart rate, sweating, during Rebounder use with High Dose Oxygen Therapy and Ozone Sauna Therapy, If one inhales gaseous ozone there would be an acute, uncontrollable coughing episode with no long-lasting health consequences, within 10 minutes breathing is back to normal, or if gaseous ozone gets in contact with the eye, there would be a transient burning and itching with again, no long-lasting effect, allergic reaction to mixture of 02 and 03 would be unusual, feeling of warm to burning sensation in area of ozone application, Some people may feel “flu like” symptoms” for 1-3 days following ozone sessions, Sense of extreme relaxation or tired feeling from Ondamed regulating adrenals and nervous system, Emotional release due to frequencies penetrating body nudging stuck/held emotions to the surface, Changes in mood, personality and thought patterns due to healing of brain and nervous system and possible increase or decrease in challenges/ symptoms due to using any healing equipment, may occur. CH utilizes lasers (light), and frequency emitting devices to restore and reconnect cellular communication in the body, while some of CH devices and equipment are approved by the FDA, many are still considered experimental and therefore not approved by the FDA, even though many practitioners utilize, PEMF, pulsed electromagnetic frequency devices and lasers, etc. I understand that oxygen and ozone therapy in medicine has been used in the USA since 1885 and that this therapy has been grandfathered for medical use prior to the formation of the FDA. I understand that the application of ozone involves a mixture of oxygen and ozone in the form of a gas, and it is applied to the skin with sauna and aesthetic sessions, and used in the same way for internal ozone insufflations. I understand that ozone/oxygen therapy is defined as the creation of a therapeutic oxygen rich environment, which induces a multi-factorial positive biochemical and physiologic change in the affected tissues, and has the following relevant and useful properties: it kills bacteria, viruses, fungi and parasites. It is a circulatory stimulant, a wound cleanser, an accelerant for healing, a hemostatic agent, and an immune activating agent. There may be other effects that at this time are unknown. The FDA has not reviewed or approved of statements made in this informed consent. Results may vary. No claims are made regarding the application of any particular therapy using any particular products for any particular reason. I understand with all treatments at CH, there is no guarantee that I will obtain satisfactory results. I may achieve no results, satisfactory results, or unsatisfactory results. If I am currently under the care of a physician or dentist for a known or unknown condition(s), it is my responsibility to inform all practitioners that are providing treatment(s) for my condition(s), of ALL other courses of treatment that I am receiving. CH has advised me that it is in my best interest to integrate all therapeutic modalities that are available to treat my health condition(s) and for my care to be managed by one primary physician. I understand that most insurance companies have determined that the devices used at CH, listed prior, including oxygen and ozone therapies to be experimental due to lack of large research studies in the scientific literature and the insurance companies will not pay for these modalities. I have been offered ample opportunity to ask questions and have received answers that are to my complete satisfaction.

By signing below, you acknowledge and agree that:

~You have been provided with information regarding the CH’s privacy practices, and such information is included as Schedule A attached hereto, titled “Notice of Privacy Practices.”

~A CH Trained team member, physician and/or medical professional has adequately explained the CH Circuit Healing Stations and uses/procedures for each station, along with the risks, benefits, alternatives and potential side effects of each, and answered any questions or concerns you may have. Alternatives to utilizing healing devices and equipment at CH include, seeking similar or different healing modalities and services elsewhere.

~You have had the opportunity to ask a physician, medical professional or Trained CH Team Member, questions regarding the Circuit Healing Stations and Private Room Add-On Sessions available to you , along with Supplementation we offer, including vitamins, liquids, powders, creams, and topical aesthetic products, and all such questions have been answered to your satisfaction. You have received all of the information you desire with respect to the CH Circuit Healing Stations and Private Room Add-on Sessions, along with supplementation, liquids, powders, creams, and topical aesthetic products, and you have read and understand all of the information described in this Informed Consent.

~The devices, equipment, supplements, products nor any treatments at CH, will not, and are not intended to cure any underlying diagnosed or undiagnosed medical condition you may have and are not an alternative to medical treatment by licensed medical professionals. Your CH modalities and treatments are not an alternative to medical attention that can be provided at a hospital or by your primary care physician.

~You hereby voluntarily authorize and consent to the administration of the healing devices and equipment, treatments and supplements at CH, and are aware of the risks, benefits and side effects associated with each.

Media Consent 

For good and valuable consideration, receipt of which is hereby acknowledged, the undersigned hereby irrevocably grants to Heal Transformation System, LLC dba, CH, including its affiliates, partners, officers, directors, shareholders and representatives (including any and all advertising and marketing agencies or other third parties authorized by CH) (collectively, THE CH Parties”), the following rights:

The right to photograph, video, record and otherwise reproduce and use, in whole or in part, and in any manner throughout the world without restriction, the use of healing circuit stations, therapies, testing, procedures, treatments, supplements and aesthetic topicals, or other procedures provided to me by CH. Such rights, include, without limitation, (i) the right to photograph, video or record me, including the rights to edit, modify or alter such photographs, videos or recordings, and (ii) the right to use, distribute, exhibit, publish and exploit my name, likeness, voice, biographical information and photographs, videos, recordings, or other materials inclusive of me or my name, voice or likeness (collectively, the “Materials”) for any legal purpose, including in connection with any advertising, publicity or promotions with respect to, or involving, CH Parties (including, without limitation, on the CH website, social media channels and / or promotional emails) by any means, in any media now known or hereafter discovered and in any and all languages, throughout the world and without restriction.

I further acknowledge and agree that (i) I have no rights in the Materials, (ii) I have no right to enjoin or impair the production or exploitation of the Materials, (iii) I have no right to approve or withhold my permission to use the Materials, (iv) I have no right to any compensation for any use of the Materials, and (v) CH is not obligated to utilize any of the Materials or rights granted herein.

Release of Claims 

I hereby waive, release and discharge CH Parties and medical director Dr. Brett Florie, MD (MD Hydration, Inc. dba The Hydration Room) from any and all claims, liabilities, demands, causes of action, costs, expenses, attorneys’ fees, damages, indemnities and obligations of every kind and nature, in law, equity, or otherwise, known and unknown, suspected and unsuspected, disclosed and undisclosed, arising out of or in any way related to (i) this Informed Consent and Release of Claims, (ii) Use of any of the Circuit Healing Stations and Private Room Add-on’s, and any of the devices, equipment, treatments, supplements or aesthetic topicals, or services received at CH, including without limitation, any injuries, side effects, allergic reactions or other medical consequences to you related to the use of any of the Circuit Healing Stations and Private Room Addon’s, and any of the devices, equipment, treatments, supplements or aesthetic topicals, services or purchases and use of aesthetic topicals, received at CH, including without limitation, any injuries, side effects, allergic reactions or other medical consequences to you in connection therewith (iv) any use of the Materials or any of the rights granted herein, (v) any act or omission of CH Parties, and (vi) any claims pursuant to any federal, state or local law or statute including, but not limited to, tort law, contract law, fraud, defamation, right of privacy, right of publicity and / or physical or emotional distress. I further agree not to initiate any proceeding based upon the claims released herein. In giving the above release, which includes claims that may be unknown to me, I acknowledge that I have read and understand Section 1542 of the California Civil Code which reads as follows: “A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.” I hereby expressly waive and relinquish all rights and benefits under that section and any law of any jurisdiction of similar effect with respect to my release of any unknown or unsuspected claims I may have against CH Parties. This Informed Consent and Release of Claims is binding upon and inures to the benefit of CH Parties’ successors, assigns, licensees and all other persons, firms and corporations claiming under or through the CH Parties.

This Informed Consent and Release of Claims shall also be binding upon my executors, administrators, heirs, beneficiaries, personal representatives, successors and assigns. I acknowledge and agree that I am at least 18 years of age, and have the right to contract in my own name. If I am not 18 years of age, my parent or legal guardian signing below has the full power and authority to sign this Informed Consent and Release of Claims. This Informed Consent and Release of Claims shall be enforced and construed pursuant to the substantive laws of the State of California. In the event of a dispute hereunder, I agree to the terms and conditions set forth in the arbitration agreement attached hereto as Schedule B. I have read and fully understand the information, disclosures, terms, conditions and releases contained herein, and voluntarily agree to all of the foregoing:

SCHEDULE B ~ ARBITRATION AGREEMENT

Agreement to Arbitrate

It is understood that any dispute between you and CH, (defined below), including without limitation, as to whether any services rendered by HEAL Transformation System, LLC, dba CH, or any of its employees, independent contractors, agents, and/or other service providers (collectively, “CH”) to you were unnecessary or unauthorized or were improperly, negligently or incompetently rendered, will be determined by submission to arbitration as provided by California law, and not by a lawsuit or resort to court process except as California law provides for judicial review of arbitration proceedings. Both parties to this Arbitration Agreement, by entering into it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration.

All Claims Must Be Arbitrated

It is the intention of the parties that this Arbitration Agreement shall cover all claims or controversies whether in tort, contract or otherwise, and shall bind all parties whose claims may, among other things, arise out of or in any way relate to treatment or services provided or not provided by CH to you.

Procedures and Applicable Law

A demand for arbitration must be communicated in writing by U.S. mail, postage prepaid, to all parties, describing the claim against CH, the amount of damages sought, and your name, address and telephone number and (if applicable) your attorney. The parties shall thereafter select a neutral arbitrator who was previously a California superior court judge, to preside over the matter. Both parties shall have the absolute right to arbitrate separately the issues of liability and damages upon written request to the arbitrator. You shall pursue your claims with reasonable diligence, and the arbitration shall be governed pursuant to Code of Civil Procedure (1280- 1295) and the Federal Arbitration Act (9 U.S.C. 1-4). The parties shall bear their own costs, fees and expenses, and shall equally share the costs of the neutral arbitrator’s fees and expenses.

Retroactive Effect

You intend this Arbitration Agreement to cover all services rendered by CH, not only after the date it is signed, but also before it was signed.

Revocation

This Arbitration Agreement may be revoked by written notice delivered to CH within 30 days of signature and if not revoked will govern all services received by you.

Severability Provision

In the event any provision(s) of this Arbitration Agreement is declared void and/or unenforceable, such provision(s) shall be deemed severed therefrom and the remainder of the Arbitration Agreement shall be enforced in accordance with California law. The undersigned understands that he or she has the right to receive a copy of this Arbitration Agreement. By my signature below, I acknowledge that I have received a copy of this Arbitration Agreement, or declined to receive a copy.

NOTICE: BY SIGNING AGREEMENT YOU ARE AGREEING TO HAVE ANY ISSUE RELATED TO CLUB HEAL’S SERVICES DECIDED BY NEUTRAL ARBITRATION AND YOU ARE GIVING UP YOUR RIGHT TO A JURY OR COURT TRIAL.

Date: March 29, 2024

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