IMPORTANT! All information presented in this website is intended for informational purposes only and not for the purpose of rendering medical advice.

**MUST BE 25 YEARS OF AGE OR OLDER TO RECEIVE HRT TREATMENT**

Therapies cannot be provided unless your physical exam, medical history, and lab work show a clinical need. Completing the required forms, lab work and exams doesn't automatically qualify you for treatment. Only the prescribing physician can determine if you qualify.

Hormone Health and Wellness of the Palm Beaches

Hormone Replacement Therapy Legal Disclaimer

In consideration of Hormone Health and Wellness of the Palm Beaches (HHW) providing medical management, administrative, and referral services to the undersigned patient, the patient hereby acknowledges and agrees to the following terms and conditions as outlined in this Patient Authorization Agreement.

1. Medical History Form:
   The patient submits an accurately completed Medical History Form (MHF) with this Agreement and agrees to provide truthful, accurate, and complete information when completing the MHF. The patient recognizes that failure to do so may affect refusal of treatment.
2. Authorization to Obtain Information:
   The patient authorizes HHW to obtain necessary medical records, laboratory results, diagnostic tests, and prescriptions from designated providers on their behalf. The patient also instructs HHW, anyone referred by HHW, and dispensing pharmacies to provide medical care and prescribe medications based on the MHF and other submitted information. The patient agrees to present valid photo identification for any blood tests conducted under HHW or blood work requisitions.
3. Insurance Disclaimer:
   The patient acknowledges that the therapies and laboratory services provided by HHW or physicians are not covered by Medicare or any other insurance plans.
4. Independent Contractors:
   The patient understands that HHW employees, (Patient Care Coordinators), are not licensed physicians, and that the supervising physicians arranging treatment are independent contractors. 
5. Patient Responsibilities:
   The patient agrees to follow the prescribed treatment methods, dosages, and instructions provided by the physician. If experiencing any adverse reactions or side effects, the patient will immediately cease treatment and notify HHW and the physician in writing.
6. Liability Waiver:
   The patient acknowledges that the diagnosis and treatment may involve risks and that neither HHW nor the physician guarantees specific outcomes. The patient understands the goal of hormone replacement therapy is to optimize hormone levels.
   
7. Consultation Agreement:
   The patient acknowledges that they are seeking medical consultation and consent to the physician reviewing their medical history and general health markers. The patient is aware the physician may not be licensed in their state or country, and all consultations will be considered to occur in Florida.
8. Primary Care Continuity:
   The patient confirms they are under the care of a primary care physician and will inform that physician about their hormone replacement therapy. A comprehensive physical examination by the primary care physician is recommended before starting any prescribed medication.
9. Malpractice Insurance Notice:
     Under Florida law, physicians are generally required to carry medical malpractice insurance. The patient acknowledges that the physician has chosen not to carry such insurance, which is permissible under certain conditions. Florida law stipulates penalties for physicians who fail to satisfy judgments related to malpractice claims.
10. Limitation of Liability:
      The patient agrees that HHW is not responsible for any actions or omissions of health care providers. HHW’s total liability is limited to the purchase price of products purchased through HHW. HHW and its affiliates will not be liable for any indirect or consequential damages.
11. Confidential Information:
      The patient agrees to maintain the confidentiality of proprietary business information shared during their relationship with HHW, acknowledging that disclosure may cause irreparable harm to HHW. Breach of this agreement would entitle HHW to seek legal remedies including injunctive relief and liquidated damages.
12. Governing Law:
      This Agreement is governed by the laws of the State of Florida. Any disputes will be resolved in a competent court located in Palm Beach County, Florida. The prevailing party in any litigation shall be entitled to recover reasonable attorneys' fees and costs.
13. Entire Agreement:
      This Agreement constitutes the entire understanding between the parties and supersedes all prior agreements. If any provision is found invalid, the remainder of the Agreement shall remain in effect.
14. Indemnification:
      The patient agrees to indemnify HHW and the physician against any claims arising from the patient’s failure to disclose relevant medical information or any adverse outcomes related to medical care or pharmaceuticals provided.