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.

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 needs. This includes the promotion of wellness and optimal physical and mental health, and not merely the treatment of disease.

I understand that Lumina Life Sciences provides services including lifestyle advice, supplementation protocols and the prescription of medicines, therapeutic peptides, hormones and other emerging therapeutic agents.