Disclosure Agreement

I, the undersigned patient, hereby authorize and request Dr. and/or associates or assistants of his/her choice, to treat my condition, which has been explained to me, and which I understand to be:

Regenerative Medicine / Stem Cell Therapy, including but not limited to the administration of mesenchymal stem cells, exosomes, and related adjunctive therapies (including Hyperbaric Oxygen Therapy where applicable) as part of my treatment plan at The Renue Medical Centre.

Contraindications

Stem Cell Therapy is NOT indicated for patients who have:

• Active Cancer or a history of Cancer within a period determined by the treating physician
• Active systemic or local infection
• Pregnancy
• Any condition the treating physician determines poses an unacceptable risk

I confirm that I have disclosed my complete and accurate medical history, including any current or prior diagnosis of cancer, infection, or other conditions that may affect my eligibility for treatment.

Treatment Risks

I understand that, as with any medical procedure, there are risks associated with the treatment I am about to receive. These risks may include, but are not limited to:

• Infection at the injection or IV site
• Allergic or immune reaction
• Bleeding or bruising
• Pain or discomfort at the treatment site
• Failure to achieve the desired clinical result
• Unknown or unanticipated risks, given that stem cell therapy is an evolving field of medicine

I understand that Stem Cell Therapy is considered by many regulatory bodies to be an emerging or investigational treatment, and that results vary from patient to patient. I acknowledge that no specific outcome has been guaranteed to me.

Privacy and Confidentiality

I understand that my medical records, including photographs and video taken in connection with my treatment, will be kept confidential in accordance with The Renue Medical Centre's Privacy Policy, except where disclosure is required by law or where I have separately consented to the use of my likeness or testimonial (for example, in marketing materials).

Informed Consent

I certify that I have read and fully understand the above consent, that the explanations therein were made, and that all blanks or statements requiring completion were filled in before I signed this consent. I have had the opportunity to ask questions about my diagnosis, the proposed treatment, alternative treatments, and the risks of non-treatment, and I am satisfied with the answers and explanations given.

THERE ARE NO ABSOLUTE GUARANTEES, EITHER EXPRESSED OR IMPLIED, THAT HAVE BEEN MADE TO ME CONCERNING THE RESULTS INTENDED FROM THIS PROCEDURE OR TREATMENT.

I understand that I have the right to revoke this consent at any time prior to the treatment being administered, by notifying my treating physician or The Renue Medical Centre staff, either verbally or in writing.

By signing below (or by proceeding with treatment after review of this document), I acknowledge that I have read this consent form, or have had it read to me, and that I understand its contents.

RENUEPV LLC
Paseo de los Cocoteros 55-1105, Zip Code: 63732
Nuevo Vallarta, Bahía de Banderas, Nayarit.
info@renue.healthcare
Tel: +1 (602) 428-4000