Authorization and Telehealth Consent

BY CLICKING "I AGREE," CHECKING A RELATED BOX TO SIGNIFY YOUR ACCEPTANCE, USING ANY OTHER ACCEPTANCE PROTOCOL PRESENTED THROUGH THE SERVICE, OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS CONSENT. IF YOU DO NOT AGREE TO THIS CONSENT, DO NOT CREATE AN ACCOUNT OR USE THE SERVICE. YOU HEREBY GRANT AGENCY AUTHORITY TO ANY PARTY WHO CLICKS ON THE "I AGREE" BUTTON OR OTHERWISE INDICATES ACCEPTANCE TO THIS CONSENT ON YOUR BEHALF.

IF YOU ARE EXPERIENCING A LIFE-THREATENING SITUATION, SUCH AS CONTEMPLATING SUICIDE, CALL 911 OR THE 988 SUICIDE & CRISIS LIFELINE AT 988.

By signing this Authorization, I am authorizing Vitl.Life ("VITL Healthcare"), and all of its respective affiliates and subsidiaries ("Receiving Entities") to use and disclose my Medical Information, including my Protected Health Information (collectively "Personal Information"), for the following purposes:

• Provide me with information related to my condition and provide disease management support.
• Provide me with information about offers and services from pharmaceutical manufacturers and other third parties that may be of interest to me.
• Provide pharmaceutical manufacturers and their affiliates and agents with information about me to allow them to administer applicable pharmaceutical manufacturers' patient support services program, including but not limited to understanding healthcare providers utilizing services to enhance delivery of educational materials, assessing inventory and dispensing data to improve forecasting models for future supply, and which may support my pharmacy experience and treatment journey. Such services may include copayment assistance programs, reimbursement assistance programs, drug coverage verification, nurse educator services, adherence programs, and/or related support.
• Provide me with promotional and informational materials relating to pharmaceutical manufacturers' products and services.
• Permit proper administration by pharmaceutical manufacturers and their agents for a product when I obtain that product from VITL Healthcare.

Purpose

Life-Threatening and Emergency Situations

Data Privacy and Protection

For informational purposes only, a link to the federal Centers for Medicare & Medicaid Services Open Payments webpage is provided here: https://openpaymentsdata.cms.gov.

This Consent shall be governed by and construed under the laws of the State of Texas, without regard to its conflict of law provisions.