I hereby confirm that “HUMAN PERFORMANCE HEALTH CLINIC ”, has fully explained to my absolute satisfaction all aspects negative and positive regarding my specific Peptide treatment. I hereby also confirm that I am completely satisfied with the opportunity that has been presented for me to have all of my related questions regarding but not limited to the treatment and alternative treatments answered. I have been specifically informed to the level that I completely understand and agree without compromise the following:

1. I solemnly swear that I have provided and told HUMAN PERFORMANCE HEALTH CLINIC everything to the best of my knowledge about my medical and or family medical history, if I experience an adverse effect due to misreading information, intentional and or unintentional direct or indirect, aware or unaware