‍This comprehensive consent form outlines the terms, conditions, and patient responsibilities for participating in Hormn’s telehealth services. It covers all current treatments offered (including Testosterone Replacement Therapy, Erectile Dysfunction treatment, and Weight Management programs) and will apply to any future services provided by Hormn. Please read each section carefully. By agreeing, you acknowledge that you understand the information and agree to the terms of your care with Hormn.

1. Scope of Services and Treatments Covered

Hormn’s Services: Holvex Pty Ltd trading as Hormn (“Hormn”) is an Australian telehealth clinic that provides health services via a digital platform. Current treatments include:

• Testosterone Replacement Therapy (TRT) for diagnosed low testosterone (hypogonadism)
• Erectile Dysfunction (ED) treatment (e.g. prescription medications for impotence)
• Weight Management programs (which may involve lifestyle counseling and/or medications)

This consent form also applies to any future health services Hormn may offer. By agreeing, you consent to Hormn’s entire range of services, present and future, as appropriate for your care.

2. Telehealth Consent and Hormn’s Role

Telehealth Modality: I consent to receive healthcare services via telehealth. I understand this means my consultations will occur by phone, video call, and other remote communication methods, rather than in-person visits. The nature of telehealth has been explained to me, including that:

• I will communicate with healthcare practitioners through secure audio/video or electronic systems.
• No physical examination will be performed in person; instead, I may need to describe symptoms and health history accurately and may be asked to undergo lab tests to assist in diagnosis.
• There are potential limitations to telehealth, such as technology failures or the inability to assess certain conditions remotely. If the telehealth provider deems an in-person assessment necessary, I will be advised to seek appropriate follow-up care.

Hormn as Facilitator: I understand that Hormn is a telehealth platform that facilitates my care. Hormn’s role includes:

• Connecting me with independent, licensed medical practitioners for consultation and treatment. These doctors are AHPRA-registered (Australian Health Practitioner Regulation Agency) and will evaluate my condition, make diagnoses, and prescribe treatments as appropriate.
• Organising supporting services such as pathology tests (blood work), follow-up schedules, and coordinating the logistics of processing prescriptions with partner pharmacies.
• Providing ongoing patient support and care coordination (through patient care coordinators, nurses, or support staff) to help answer questions and ensure continuity of care.

Independent Medical Practitioners: I acknowledge that the doctors and clinicians I interact with via Hormn are independent medical practitioners, not employees of Hormn. They exercise their own medical judgment in diagnosing and treating me. Hormn itself does not practice medicine or make medical decisions – it serves as the administrative platform. Accordingly:

• Any prescriptions or treatment plans are determined by the consulting doctor independently of Hormn. Hormn is not liable for the medical advice given by the independent practitioner (to the extent permitted by law).
• I agree to provide the consulting doctor with complete and accurate information about my health, including symptoms, medical history, and all medications or supplements I take. I understand that failing to disclose information or providing inaccurate information could affect the quality and safety of care.
• If I have questions or concerns about the recommended treatment or any aspect of my care, I will direct these to the medical practitioner or Hormn’s support team for clarification. I have the right to seek a second opinion or refuse a specific treatment at any time without prejudice to my future care.

Not a Substitute for Emergency Care: I understand that Hormn’s telehealth service is not intended for emergency or life-threatening conditions. If I experience a medical emergency (for example, severe chest pain, trouble breathing, signs of stroke, suicidal feelings, etc.), I will dial 000 (in Australia) or seek immediate care at the nearest hospital, instead of using Hormn’s services. Routine telehealth consultations are not equipped to handle emergency interventions.

3. Informed Consent to Treatment – Benefits, Risks, and Alternatives

I understand that as a patient of Hormn, I may receive treatment for conditions such as low testosterone, erectile dysfunction, or obesity/overweight, depending on my needs. The general purpose, benefits, risks, alternatives, and patient responsibilities for these treatments have been explained to me as follows:

• Testosterone Replacement Therapy (TRT): This therapy is used to treat clinically diagnosed low testosterone levels. Potential benefits include improved energy, mood, libido, muscle mass, and overall quality of life. Possible risks and side effects include changes in fertility (reduced sperm count and testicular atrophy leading to potential infertility), acne or oily skin, increased red blood cell count (polycythemia) which could raise risk of clots, breast tissue enlargement (gynecomastia), prostate enlargement or aggravation of prostate issues, mood swings, hair loss, and high blood pressure. There is also a risk of liver toxicity if certain oral forms are used, and injection therapy carries minor risks such as injection site pain or infection. I understand that TRT is typically a long-term or lifelong treatment – once started, my body’s natural testosterone production may decrease, and if I stop therapy I could experience a return of low testosterone symptoms. Alternatives to TRT include: not starting therapy (managing symptoms through lifestyle changes or other means), using other medical therapies (for example, clomiphene or hCG for certain cases), or seeking specialist evaluation (e.g. endocrinologist) for further options. I understand I am under no obligation to begin TRT and that I can discuss all alternative options with my doctor before deciding. I agree to comply with the specific requirements of TRT, such as regular blood tests (e.g. after 8 weeks of treatment, then every 4-6 months) to monitor my hormone levels and health indicators, and to report any side effects promptly. I will not adjust my dosage or stop treatment on my own without consulting my doctor, due to the need for medical supervision when altering hormone therapy.
• Erectile Dysfunction (ED) Treatment: Hormn’s ED treatments may involve prescription medications (for example, phosphodiesterase-5 inhibitors like sildenafil/Viagra, tadalafil/Cialis), hormone therapy if appropriate, or other therapeutic modalities as determined by the doctor. Potential benefits include improved ability to achieve and maintain an erection sufficient for sexual activity, which can enhance sexual confidence and quality of life. Possible risks and side effects depend on the treatment but for common ED medications can include headaches, flushing, nasal congestion, dizziness or lightheadedness, heartburn, vision or hearing changes (rare), low blood pressure, or in rare cases priapism (a prolonged erection that can damage tissue and is a medical emergency). I will seek urgent care if I have an erection lasting longer than 4 hours. I will also inform the doctor of any heart conditions or medications I take; I understand that ED medications must not be taken with certain other drugs (for example, nitrates used for chest pain) due to the risk of serious interactions causing low blood pressure. Alternatives to ED medications include lifestyle modifications (diet, exercise, reducing alcohol), psychotherapy or couples counseling if psychological factors are involved, vacuum erection devices, or referral to a urologist for other treatments. I have had the opportunity to discuss these alternatives. I agree to use ED medications exactly as prescribed (typically on an as-needed basis prior to sexual activity) and not to exceed the recommended dose. If the medication is not effective or causes side effects, I will inform the doctor so we can consider dose adjustment or alternatives.
• Weight Management Programs: Hormn offers weight management assistance which may include nutritional counseling, exercise guidance, behavioral coaching, and/or prescription weight loss medications (such as appetite suppressants or metabolic regulators) as appropriate to my condition. Potential benefits include weight reduction, improved metabolic health (such as better blood sugar or cholesterol levels), increased energy, and reduced risk of weight-related illnesses. Possible risks and side effects will depend on the specific program or medication. For example, dietary changes could cause fatigue or nutritional deficiencies if not properly balanced; medications might cause side effects such as nausea, gastrointestinal discomfort, diarrhea or constipation, headaches, insomnia or elevated heart rate/blood pressure (for stimulant-based appetite suppressants), or rare more serious effects (e.g. gallbladder issues or pancreatitis reported with some newer weight-loss medications). The doctor will explain the specific risks of any medication prescribed to me. Alternatives to medical weight management include self-directed lifestyle changes (diet and exercise on my own or with a local dietitian or trainer), or in certain cases, surgical interventions (like bariatric surgery) if deemed appropriate by a specialist. I understand that weight management requires active participation on my part: I will follow diet and exercise recommendations, take any medications exactly as prescribed, and report any concerning symptoms (like signs of gallbladder pain, heart palpitations, etc.) immediately. There is no guaranteed outcome, and weight loss results will vary by individual effort and biology.

General Understanding of Treatment: I acknowledge that no treatment is 100% guaranteed in effectiveness. I understand the goals and potential outcomes, and I have been informed of the risks versus benefits for each therapy recommended to me. I have also been informed of the option to refuse or withdraw from treatment at any time. If I decide to decline a recommended treatment or if I wish to stop an ongoing treatment, I will notify Hormn’s medical staff so that we can discuss safe discontinuation or alternative approaches. My consent here confirms that I understand the information given to me about these therapies, and I consent to the treatments that my Hormn provider and I have agreed upon.

Off-Label Use and International Guidelines

I acknowledge and consent that some medications and treatments prescribed through Hormn may be used off-label. This means they are prescribed for indications, doses, or administration methods not explicitly stated in the product’s Australian package insert. Hormn’s affiliated medical practitioners follow internationally recognized clinical guidelines—such as those from the International Society for the Study of the Aging Male (ISSAM), the British Society for Sexual Medicine (BSSM), and other global endocrinology or andrology authorities—in their diagnosis and management of conditions like testosterone deficiency. These practices may differ from local PBS recommendations or TGA medication labeling.

I understand that such off-label prescribing is a legitimate and common aspect of clinical medical practice and is based on a risk-benefit evaluation by the prescribing doctor, consistent with standards of care in the international hormone management community.

Sterile Vial Transfer and Medication Administration

For testosterone therapy, I understand that Hormn’s medical team may recommend the use of pre-filled syringes or the transfer of medication into a sterile vial to enable smaller, more frequent intramuscular injections. This method may provide more stable serum testosterone levels compared to less frequent dosing. While this practice is considered effective and safe by experienced hormone therapy practitioners internationally, it may differ from the manufacturer's product leaflet or Australian registration documentation.

I consent to the use of this administration method and understand the risks involved, including a potential increased risk of contamination or infection if proper sterile technique is not followed. I will follow the instructions provided regarding preparation and injection hygiene, and I will contact the care team immediately if I am unsure how to proceed or notice any complications.

4. Follow-Up Care, Monitoring, and Ongoing Responsibilities

I understand that participating in Hormn’s programs requires my commitment to regular monitoring and follow-up, to ensure my safety and the effectiveness of treatment. By signing below, I agree to the following follow-up and monitoring plan:

• Regular Consultations: I will attend follow-up consultations as advised. Hormn’s model includes regular check-ins and unlimited consultations as needed as part of the service. I can schedule telehealth follow-ups anytime I have concerns, and Hormn may also schedule routine follow-ups (for example, to review lab results or adjust treatment). I agree to actively participate in these consultations and to be responsive to communication from Hormn’s care team.
• Pathology Testing: I consent to undergo periodic pathology tests (blood tests and other labs) as recommended for my treatment. This includes baseline testing before starting treatment and ongoing tests (e.g., every 4-6 months for TRT patients) to monitor hormone levels, blood counts, organ function, and other relevant health markers. These tests are critical for ensuring that the treatment remains safe (for example, monitoring that testosterone levels stay in a healthy range and checking for side effects such as changes in liver function or blood thickness). I understand that these tests may require me to visit a local pathology collection center or use a private pathology service. Hormn will assist in ordering these tests, but it is my responsibility to complete them in a timely manner.
• Monitoring and Communication: I authorize Hormn’s medical staff to contact me with reminders or instructions regarding follow-up tests, result reviews, and appointment scheduling (this may be via phone, SMS, email, or app notifications). I will also proactively report my symptoms and any side effects during treatment. If I experience side effects or worsening of my condition, I will inform the doctor as soon as possible rather than waiting for the next scheduled appointment. I understand that ongoing communication helps my provider adjust my treatment safely.
• Compliance with Treatment Plan: I commit to following the treatment plan as closely as possible. This includes taking medications as prescribed (on schedule, correct dosages), adhering to recommended lifestyle modifications (such as diet/exercise plans in weight management), and using devices or injections as instructed (for example, administering testosterone injections in the proper manner if I am prescribed self-injection, or using ED devices safely if applicable). If I am unsure about how to follow any aspect of the plan, I will seek clarification from Hormn’s team. I will not alter or discontinue medications on my own – if I have an issue or wish to stop, I will consult the doctor to devise a safe plan.
• Consequences of Non-Compliance: I acknowledge that if I fail to attend follow-ups or do required tests, it can be dangerous to continue certain treatments (like TRT) without monitoring. If I repeatedly do not comply with monitoring requirements, the medical team may need to pause or discontinue my prescriptions for safety. Hormn will attempt to contact me if I miss a test or appointment, but ultimately it is my responsibility to ensure I complete these actions. I understand that continuation of therapy is contingent on appropriate medical monitoring, and I accept that requirement.

5. Prescription Handling and Pharmacy Consent

Hormn partners with third-party services to ensure that any prescription medications I need are dispensed safely and delivered to me. By signing this form, I give my consent and authorization for the following:

• Use of ScriptMate for Prescriptions: I allow Hormn to use ScriptMate Pty Ltd (a prescription handling service) to manage my prescriptions. This means Hormn and its affiliated doctors can electronically send my prescription information to ScriptMate, which will then coordinate with a partner pharmacy to facilitate dispensing and shipping of my medications.
• Partner Pharmacy Coordination: I consent to Hormn forwarding my prescription to one of its partner pharmacies. These partner pharmacies are licensed Australian pharmacies that will fill the prescription and arrange delivery of the medication to me. I authorize the partner pharmacy to contact me if needed to confirm details (for example, verifying my address or notifying me of delivery times).
• Information Sharing: I understand that in order to fill my prescriptions, Hormn will share necessary personal and health information with ScriptMate and the dispensing pharmacy, including my full name, contact information, delivery address, and prescription details (medication name, dose, quantity, and relevant medical information). This information is shared only for the purpose of fulfilling my prescription and delivering my treatment. I consent to this disclosure of my information, and I understand it will be handled in accordance with Hormn’s Privacy Policy and the privacy policies of ScriptMate and the pharmacy (all of which comply with Australian privacy laws).
• Medication Dispensing and Delivery: I acknowledge that Hormn itself is not a pharmacy and does not stock or dispense medications. The medications I receive will come from the partner pharmacy. Hormn’s role is to coordinate this service for my convenience. I authorize the pharmacy to dispense the prescribed medications on my behalf and deliver them to me by mail or courier. I will ensure someone is available to receive the package at the address I provide, and I will follow any instructions provided for storage (e.g., refrigeration if required for certain medications) once I receive the package.
• Consent for Pharmacy Communication: I agree that the pharmacy or Hormn may contact me via phone or email to coordinate the dispensing, such as to confirm my order or address, or to provide tracking information. I also consent to receiving necessary education or counseling from the pharmacist about my medication (either by phone or written material included with the medication), as is standard practice for prescription dispensing.
• Medication Quality and Issues: Once delivered, I will check the medication package. If there are any issues – for example, damaged medication, incorrect supply, or if I have questions about usage – I will notify Hormn and/or the pharmacy promptly. I understand that returns or refunds on medications are generally not permitted once they have been dispensed, for safety reasons, unless there is a confirmed error or defect. In the rare case that medication is faulty or incorrect, Hormn and the pharmacy will work with me to resolve the issue (either by replacement or refund in line with the pharmacy’s policies). I will not use any medication that appears tampered with, and I will dispose of any such product as instructed by the pharmacy.
• No Controlled Substances Without ID: (If applicable) I understand that if any prescribed medication is a controlled substance or regulated, I may be required to provide identification or sign for the delivery to ensure legal compliance. I will cooperate with any such requirements to receive my prescription.

6. Financial Terms and Billing Agreement

I acknowledge and agree to the following terms regarding fees, billing, and payments for Hormn’s services:

• Membership Subscription Fee: Hormn operates on a membership model. I will be charged a monthly subscription fee. This fee is for the Hormn service itself – it covers the cost of my ongoing care management, including access to unlimited telehealth consultations and follow-up appointments, support from the care team, and the administrative services Hormn provides (such as coordinating tests and prescriptions). This fee is private billing (not covered by Medicare) and will be billed to me on a recurring monthly basis. There is no lock-in contract; the service is pay-as-you-go monthly.
• Medication Costs: The cost of any prescribed medications is separate from the membership fee. I will need to pay for my medications, which are dispensed by the partner pharmacy. The exact cost of my medication will be communicated to me when prescribed. ScriptMate will either charge my payment method on file or send an invoice/payment link for the medication cost on behalf of the partner pharmacy. If multiple treatments or medications are prescribed (e.g., an estrogen blocker or other adjunct therapy with TRT, or different medications for ED or weight loss), each will have its own cost which I am responsible for. Medication charges will generally occur on a per-order basis (e.g., monthly or bi-monthly when refills are shipped). I acknowledge that medication costs can change and may depend on market prices or the specific pharmacy’s pricing; Hormn will endeavor to inform me of any significant pricing changes in advance.
• Pathology Testing Costs: Hormn uses private pathology services, these tests are not covered by Medicare(since the panels are comprehensive and may not meet Medicare criteria for coverage). I will budget for these expenses as needed (for example, TRT patients can expect blood tests a few times a year).
• Consultation Fees: Apart from the subscription, outside of the initial consultation I will not be charged extra for individual telehealth consultations with Hormn’s doctors or staff – these are included in the membership fee (unlike a traditional clinic where you might pay per visit). However, if I miss a scheduled appointment without notice or cancel last-minute, there may be a cancellation fee or policy (Hormn will inform me of their missed appointment policy if applicable). At this time, the membership model means there is flexibility in scheduling and I am encouraged to use consultations as needed without fear of additional cost.
• Payment Method and Authorization: I will provide a valid credit card or debit card (or an approved payment method) to be kept on file for automatic billing. I authorize Hormn to charge my card each month for the subscription. I also consent to the partner pharmacy charging my card for medication orders, or to pay those invoices promptly through the provided payment link. All charges will be communicated to me (via email receipt or in the Hormn patient portal). I am responsible for keeping my payment information up to date. If a charge is declined (e.g., card expired or insufficient funds), I will update my details; I understand that failure to pay membership fees might result in suspension of services.
• Private Insurance and Medicare: Hormn is a 100% private billing service. This means Medicare rebates do not apply to consultation fees or pathology organized through Hormn. If I have a private health insurance policy, I may check whether it provides any reimbursement for telehealth, prescriptions, or blood tests. Hormn has informed me that some private health funds allow claiming a portion of prescription costs (after purchase) – I can request a pharmacy receipt for this purpose. Ultimately, it is my responsibility to inquire and claim from my insurer if eligible; Hormn does not directly bill insurance. All fees are generally out-of-pocket.
• Refund and Cancellation Policy: I acknowledge Hormn’s policies on refunds and cancellation of services:
  • No refunds for services already rendered: Once I have had a consultation or received a treatment plan, the subscription fee for that period is not refundable, except at Hormn’s discretion in special cases. Similarly, once a medication is dispensed and shipped, it cannot be returned or refunded (unless it was faulty) for safety reasons.
  • Initial consultation refund exception: If after my initial doctor consultation I decide not to proceed with any treatment, Hormn may offer a refund of the membership fee for that first month provided I notify them within a few days after the consult. This is intended for situations where a patient is found not eligible for treatment or chooses not to continue immediately after learning the medical information. I understand this is a goodwill gesture and must be requested promptly; it may not apply if prescriptions have already been written and processed.
  • Cancellation of subscription: I can cancel my Hormn membership at any time. There is no long-term contract. To cancel, I should contact Hormn’s support (via email or through the patient portal) and receive confirmation. If I cancel, I will not be charged for any further months after the current billing cycle. No cancellation fees apply. However, fees already paid for the current month will typically not be refunded (I will continue to have access to services for the remainder of the paid period). Hormn asks for advance notice (e.g., a few business days before the next billing date) to ensure the auto-payment is stopped in time.
  • Cancellation of treatment vs. membership: If I decide to stop a particular treatment (like discontinue TRT), I should still formally cancel the membership if I no longer wish to use Hormn’s services at all. Otherwise, the subscription will remain active. Conversely, if I cancel membership, I should coordinate with the doctor about safely discontinuing any ongoing medications. Hormn will not be obligated to continue managing my care or prescriptions after cancellation, so it’s important I have a plan for any necessary medical follow-up.
  • Refunds for faulty medication or errors: If the pharmacy supplies a faulty product (e.g., damaged vials, etc.) or the wrong medication, I am entitled to a correction. In line with standard pharmacy policy, the pharmacy will replace the product or refund the medication cost in such cases. I will report any issues immediately to facilitate this process. This is the only circumstance where a medication-related refund would apply.
  • Unforeseen circumstances: If there is an issue on Hormn’s side (for example, inability to provide a promised service or a significant error in billing), Hormn will address it case-by-case, potentially offering refund or credit if warranted. They have a support channel for billing disputes, which I can utilize if needed.
• Acknowledgment of Financial Responsibility: By consenting to treatment through Hormn, I accept that I am financially responsible for all fees as outlined above. I will not hold Hormn responsible for costs I incur outside their service (for example, if I independently seek additional tests or treatments not arranged by Hormn, those costs are mine to bear). I understand the pricing structure and have had an opportunity to ask questions about what is included or not included in the fees. All amounts were clearly communicated to me upfront, and I agree to pay for the services rendered.

7. Privacy and Confidentiality

Your privacy is very important to Hormn. This section summarizes how your personal information is handled:

• Compliance with Privacy Laws: Hormn will collect, use, and store my personal health information in compliance with the Australian Privacy Act 1988 and other relevant laws. I have been provided access to Hormn’s Privacy Policy (available on their website) and I agree to its terms regarding how my data is managed. My data will be kept confidential and used only for the purposes of providing me with healthcare services, administering my account, and as otherwise permitted by law.
• Use and Disclosure of Information: I consent to Hormn using my health information to facilitate my care. This includes sharing necessary details with the medical practitioners who treat me, with pathology providers for tests, with ScriptMate and partner pharmacies for prescription fulfillment, and with any other healthcare providers or specialists to whom I am referred. I understand Hormn may also use my contact information to send me health reminders, educational materials, or service updates. Hormn will not disclose my information to third parties for marketing purposes without my explicit consent, and does not sell patient data.
• Data Security: Hormn employs measures to protect my data, such as encryption and secure databases. However, I am aware that no system is completely immune to risk. By using telehealth and electronic communication, I acknowledge there is a minor risk of privacy breaches (for example, if emails are intercepted or if I share a computer). I will do my part to protect my privacy by using secure networks and keeping my Hormn account credentials confidential. If I suspect any breach of my data or unauthorized access, I will inform Hormn immediately.
• Access and Corrections: I have the right to access my health information held by Hormn and to request corrections if I identify any inaccuracies. I can contact Hormn’s privacy officer or support team to make such requests. Hormn will provide me access in a reasonable time frame, subject to any legal limitations.
• Retention of Records: I understand that Hormn will retain my medical records for the period required by law (which in Australia is generally 7 years or longer, especially if I was a minor at time of treatment or as required by professional guidelines). My data will be archived securely and only accessed if necessary (for example, if I return for services or as needed for legal reasons).
• Consent to Electronic Communication: I consent to Hormn sending me communications about my medical care (including sensitive information such as test results or diagnoses) via electronic means (email, SMS, or through secure portals). I understand Hormn will do so in a secure manner to the best of their ability. I can request more secure or alternative communication methods if I have particular concerns.

By agreeing to this form, I am also confirming that I have read or had the opportunity to read the Hormn Terms & Conditions and Privacy Policy in full, and I accept them as a condition of receiving care. I know I can ask for a copy or clarification of these documents at any time.

8. Patient Responsibilities and Acknowledgments

In addition to the specific points above, I make the following general acknowledgments and commitments regarding my participation in Hormn’s telehealth treatment program:

• Accuracy of Information: I affirm that all information I have provided (and will provide in the future) to Hormn and its medical practitioners is truthful and complete to the best of my knowledge. This includes my medical history, symptoms, lifestyle habits, and any use of medications or supplements. I will not deliberately withhold any information that might be relevant to my care (such as a history of heart disease, psychiatric conditions, substance use, allergies, etc.). I understand that accurate information is crucial for safe treatment outcomes.
• Questions and Understanding: I acknowledge that I have been given ample opportunity to ask questions about my condition, the recommended treatments, and this consent form. Hormn’s representatives have answered my questions to my satisfaction. I understand the content of this form and all explanations provided. If I have questions in the future, I know that I can contact Hormn’s support or bring them up in a consultation. I will seek clarification on any aspect of my care that I do not understand.
• No Guarantees of Cure: I understand and accept that medicine is not an exact science and no specific results or guarantees have been made to me regarding the outcomes of treatment. While Hormn’s team will work to help me achieve improved health, there is no promise that the treatment will meet all my expectations or that it will completely resolve my issues. My improvement is contingent on many factors, including my adherence to the treatment plan and individual variation.
• Risks Acknowledged: I have been informed of the foreseeable risks and side effects associated with my treatment plan (as detailed earlier in this form for TRT, ED, weight management, etc.) and I accept these risks in order to pursue potential benefits. I will immediately report any serious or concerning side effect to Hormn. If new risks are identified or if my treatment changes, I expect to be informed and I will be given a chance to consent to any new treatment.
• Alternatives and Right to Refuse: I acknowledge that I have been told about reasonable alternatives to the proposed treatments (including doing nothing or seeking other medical advice), and the pros and cons of those alternatives. I understand I am free to refuse or withdraw from treatment at any time. If I withdraw, I will inform Hormn so they can advise me on how to do so safely (particularly important for hormone therapies that should be tapered or require monitoring when stopping). I understand that if I withdraw consent or discontinue the membership, I may no longer receive services from Hormn, but I can always seek care elsewhere.
• Independent Nature of Care Providers: I reiterate that I understand Hormn is a platform connecting me to doctors, and those doctors are ultimately responsible for my medical care. Hormn is not a traditional clinic or pharmacy – it does not itself diagnose or prescribe (the doctors do), and it does not dispense medication (the pharmacy does). Therefore, I agree that I will not hold Hormn Pty Ltd liable for any injury or loss that arises from medical advice or prescriptions given by the treating doctor, or from pharmacy errors, except to the extent that Hormn’s own negligence directly contributes to that issue. (This does not waive my rights under Australian Consumer Law or medical negligence law; it simply acknowledges the division of responsibility in my care). If I have any legal claims or disputes, I understand they may involve the medical practitioner or pharmacy individually, but Hormn’s role is administrative/facilitative.
• Practitioner Availability and Reassignment: Hormn is committed to timely care. If your assigned doctor is unavailable, delays your treatment, or is unable to provide a consultation within a clinically appropriate timeframe (e.g., more than 6 days), Hormn may offer to reassign you to another licensed practitioner. In cases where your assigned doctor is no longer working with Hormn, we may reassign your care automatically to another qualified practitioner to ensure continuity of treatment without interruption. You consent to such reassignment where clinically or operationally required.
• Emergency Plan: I have been advised what to do in case of an emergency (see Section 2 above). I will not rely on Hormn for emergency care. I have a plan to contact local emergency services or present to a hospital if I experience severe adverse reactions or urgent health issues. I also have been advised that if I cannot reach Hormn or the doctor in an urgent situation, I should seek appropriate care without delay.
• Follow Medical Advice: I agree to follow the medical advice and treatment plan given to me as closely as possible. If I choose not to follow the advice (for example, not taking medication or skipping tests), I will inform my provider, and I accept that doing so may compromise the effectiveness or safety of the treatment. The medical practitioner may also decide to reassess or change my treatment if I am non-compliant, or may require me to sign an additional waiver if I insist on continuing treatment contrary to advice.
• Lifestyle Commitments: Where applicable (especially in weight management or general health), I will make a good-faith effort to implement recommended lifestyle changes (diet, exercise, reducing alcohol or tobacco, etc.) as these often work in tandem with medical treatments for best results. I understand my health outcomes are a partnership between me and my healthcare providers.
• Confidentiality of Services: I will respect that the telehealth consultations are private medical appointments. I will not record consultations without informing my doctor (just as I am assured the doctor will not record me without consent, except for clinical documentation purposes). If I wish to have a family member or partner sit in on a telehealth session or have access to my medical information, I will discuss it with Hormn and sign any additional consent if required for sharing information with third parties.

By acknowledging all the above, I take an active role in my health care and understand both my rights and responsibilities as a patient of Hormn.

9. Patient Declaration

Patient Declaration: I, the patient, confirm that I have read (or had read to me) this Hormn Telehealth Treatment Consent Form in its entirety. I understand the contents, implications, and consequences of the services and treatments described. All my questions have been answered to my satisfaction. I have had sufficient time to consider my decisions regarding treatment via Hormn.

I hereby freely give my informed consent to enroll in Hormn’s telehealth services and to receive the indicated treatments (including TRT, ED therapy, weight management, and any other agreed services), under the conditions outlined above. I understand that I may withdraw this consent at any time in the future, which would halt further treatment, and that it is my responsibility to communicate any such decision and to arrange appropriate follow-up.

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