Purpose of Treatment

I understand that I am engaging in a telehealth consultation with Lumina Life Sciences, a licensed medical provider operating under DHA guidelines, for the purpose of assessment, diagnosis, and management of my health, hormonal, and longevity-related needs, which may include the prescription of peptide, hormone, or other emerging therapeutic agents.

Nature of Telehealth Services

I acknowledge and consent to receive healthcare services via telemedicine, which involves the use of digital communications to facilitate medical evaluation, diagnosis, prescription, and follow-up.

• My clinician may not be physically present during the consultation.
• I have the right to request an in-person consultation at any time.
• All medical records and data will be securely stored and managed in accordance with Dubai Health Authority (DHA) data protection, privacy, and telehealth standards.
• Telehealth may have limitations, including potential interruptions or security risks inherent to digital communications.

Off-Label and Emerging Therapies

I understand that peptide and certain hormone therapies offered by Lumina Life Sciences may be used for “off-label” purposes , meaning they may not be specifically approved by international or UAE regulatory authorities for the indication being treated.

• Off-label use is a recognized and lawful medical practice when determined appropriate by a licensed clinician.
• My clinician has explained the intended benefits, potential risks, and limitations of such treatments.
• These therapies may not have undergone long-term safety studies for all indications.
• My participation is voluntary, and I may discontinue treatment at any time.
• Lumina Life Sciences does not guarantee specific results or outcomes.

Potential Risks and Side Effects

I have been informed that possible side effects of peptide, hormone, or adjunct therapies may include but are not limited to:

• Injection site irritation, redness, or swelling
• Nausea, headache, dizziness, fatigue, or mood changes
• Hormonal fluctuations (including libido, sleep, or weight changes)
• Fluid retention or electrolyte imbalance
• Rare allergic or hypersensitivity reactions

• All medications and compounds are prescribed and compounded under medical supervision.
• I will report any adverse reactions promptly to my clinician.
• Emergency medical attention is available if serious side effects occur.

Medical Disclosure

• I have provided a complete and accurate medical history to Lumina Life Sciences.
• I have disclosed all current medications, supplements, and pre-existing conditions.
• I will notify my clinician of any new symptoms, medications, or diagnoses that arise during treatment.

• All medications and compounds are prescribed and compounded under medical supervision.
• I will report any adverse reactions promptly to my clinician.
• Emergency medical attention is available if serious side effects occur.

Confidentiality & Data Protection

I understand that:

• My personal and medical data will be protected under UAE ICT and DHA patient data confidentiality laws.
• My data may be shared only with authorized medical professionals involved in my care.
• Digital records will be encrypted and securely stored on DHA-approved platforms.

Financial and Treatment Responsibility

I acknowledge that:

• I am responsible for all associated treatment and consultation fees.
• Compounded medications may not be covered by insurance.
• I have had the opportunity to discuss costs and understand all payment terms prior to initiating therapy.

Informed Consent Acknowledgment

I confirm that:

• I have read and understood the information provided in this consent form.
• I have had the opportunity to ask questions regarding telehealth services, peptide therapy, hormone optimization, and off-label treatments.
• My questions have been answered to my satisfaction.
• I understand that results vary and are not guaranteed.
• I consent voluntarily to participate in this treatment program.