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Aim Health And Wellness Membership Contract

This Membership Contract ("Contract") is entered into between AIM Health and Wellness ("Practice"), located at 65 E. Northfield Rd. Livingston, NJ Suite L. 07039, and the undersigned member ("Member")

1. MEMBERSHIP TERM AND COMMITMENT The Member agrees to a twelve (12) month membership commitment ("Membership Term"), commencing on:

The Membership Term shall automatically renew for successive twelve (12) month periods unless terminated in accordance with this Contract. the membership will continue renewal beyond 12 months as patient continues with care. 

2. MEMBERSHIP FEES AND RECURRING PAYMENTS a. The Member shall pay a monthly membership fee of designated amount based on personalized treatment plan as explained by the provider b. The Membership Fee shall be automatically charged to the Member’s designated payment method on the same day of each month during the Membership Term. c. The Member authorizes the Practice to initiate recurring payments for the Membership Fee and any applicable taxes or fees. The Member shall provide valid payment information and promptly update the Practice with any changes. d. Late payments may incur a late fee of $\[25\] per occurrence. The Practice reserves the right to suspend or terminate membership for non-payment. 


3. MEDICAL REVIEW a. The Member shall participate in a mandatory medical review with a Practice provider to assess health status and compliance with recommended treatments, follow-up, and lab work.  


4. CANCELLATION AND TERMINATION a. Practice’s Right to Cancel: The Practice may cancel the Member’s membership at any time, with or without notice, for: i. Failure to comply with prescribed medical treatments, follow-up appointments, or lab work. ii. Aberrant behavior, including but not limited to disruptive, abusive, or inappropriate conduct toward Practice staff, providers, or other members. noncompliance with prescribed medication iii. Non-payment of Membership Fees or other outstanding balances. Upon cancellation by the Practice, the Member shall remain liable for any outstanding fees or charges incurred prior to cancellation. b. Member’s Right to Cancel: i. The Member may request cancellation of their membership by submitting a written request to the Practice or in person at the Practice’s office. ii. Prior to cancellation, the Member must complete an exit consultation with a Practice provider to review health status and finalize membership obligations. iii. The Member’s request for cancellation will be processed only after the exiting consultation is completed. iv. Recurring payments will continue until the exiting consultation is performed, and cancellation is finalized. c. Effect of Cancellation: Upon cancellation, the Member shall no longer have access to membership benefits or services. Any prepaid fees for the remaining Membership Term are non-refundable, except as required by applicable law. 


5. MEMBER OBLIGATIONS a. The Member agrees to comply with all prescribed medical treatments, follow-up appointments, and lab work as directed by Practice providers. b. The Member shall provide accurate and complete health information to the Practice and promptly notify the Practice of any changes. c. The Member shall conduct themselves in a respectful and appropriate manner at all times while interacting with Practice staff, providers, and other members. 


6. LIMITATION OF LIABILITY The Practice shall not be liable for any indirect, incidental, or consequential damages arising from the Member’s participation in the membership or use of Practice services, except as required by applicable law. 


7. GOVERNING LAW This Contract shall be governed by and construed in accordance with the laws of the State of New Jersey, without regard to its conflict of law principles. 


8. ENTIRE AGREEMENT This Contract constitutes the entire agreement between the Practice and the Member and supersedes all prior agreements or understandings, whether written or oral, relating to the subject matter herein. 


9. AMENDMENTS The Practice reserves the right to amend this Contract at any time by providing written notice to the Member. Continued participation in the membership after such notice constitutes acceptance of the amended terms. 

MEMBER ACKNOWLEDGMENT I,

have read, understood, and agree to be bound by the terms and conditions of this Contract. I authorize the Practice to charge my designated payment method for the recurring Membership Fee and acknowledge my obligations under this Contract. 

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PRACTICE ACKNOWLEDGMENT
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AIM Health Consent Form

Peptide Therapy and Hormone Replacement Therapy Informed Consent Form 

Date of Birth
Month
Day
Year

Introduction 

You are being considered for peptide therapy and or Hormone Replacement Therapy, which involves the use of amino acid sequences (peptides) and/or Bioidentical Hormone Replacement Therapy and/or Hormone Signaling Medications ( Clomid, Enclomiphene) that may assist in optimizing various physiological functions such as hormone regulation, tissue repair, fat loss, cognitive function, sleep quality, and musculoskeletal recovery. This therapy is considered off-label in many cases and is not FDA-approved for all proposed uses. 


Hormones may include (But are not limited to): 


  • Testosterone 

  • Estradiol 

  • Clomid/ Clomiphene  

  • Enclomiphene 

 

Peptides May Include (but are not limited to): 


  • Sermorelin 

  • Ipamorelin 

  • Tesamorelin 

  • BPC-157 

  • Thymosin Alpha-1 / Beta-4 

  • CJC-1295 

  • MOTS-c 

  • GHK-Cu 

  • Compounded GLP –1 peptide

  • Kisspeptin


(The specific peptide(s) prescribed will depend on your individual needs and goals, as determined by your provider). 


Potential Benefits 

  • Improved energy, metabolism, and body composition 

  • Enhanced recovery and injury healing 

  • Better sleep and cognitive function 

  • Optimized hormone levels 

  • Fat loss and/or improved lean muscle mass 

  • Enhanced immune function 


Risks & Side Effects 


Possible side effects include, but are not limited to: 


  • Injection site reactions (redness, swelling) 

  • Headaches, fatigue, or dizziness 

  • Nausea or gastrointestinal upset 

  • Water retention 

  • Hormonal imbalances 

  • Potential stimulation of pre-existing cancer cells (if undiagnosed malignancy is present) 

  • Unknown long-term effects (many peptides are still under study) 


Contraindications 


You may not be a candidate if you have: 


  • Active or past history of cancer 

  • Uncontrolled diabetes 

  • Uncontrolled Blood Pressure 

  • Uncontrolled Sleep Apnea 

  • Liver or kidney disease 

  • Active infections or autoimmune disorders (depends on peptide) 

  • Pregnancy or are nursing 

  • Known allergy to any ingredients in the peptide formulation 


Treatment Plan & Expectations 


  • Peptide and/ or Hormone Replacement therapy is individualized and may require adjustments based on lab results and response. 

  • Treatment duration may vary (generally 3–6 months or more). 

  • Follow-up labs and visits are required for monitoring progress and safety. 

  • Compliance with dosing, follow-ups, and reporting of side effects is essential. 


Cost and Payment 


  • This Treatment is provided by the AIM Health Wellness division and is inclusive of medical professional supervision under a Membership program that includes medical evaluations, Follow up care and re-assessments, Lab review, prescription writing and monitoring.   

  • You are responsible for all out-of-pocket expenses related to Lab work  

  • No prescriptions or follow up care will be provided unless until Membership payment is received and up to date. 

Voluntary Consent 

I understand that peptide therapy is elective and off-label. I have had the opportunity to ask questions, and all questions have been answered to my satisfaction. I understand the potential risks and benefits and wish to proceed with peptide therapy as recommended by my provider. 

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