Membership Consent

PLEASE READ THIS DOCUMENT CAREFULLY BEFORE USING OUR SERVICES.

IMPORTANT EMERGENCY NOTICE

AESTHETICA IS NOT A PROVIDER OF EMERGENCY MEDICAL SERVICES. IF YOU HAVE A MEDICAL EMERGENCY, SEEK IMMEDIATE IN-PERSON MEDICAL CARE, CALL 911, OR CONTACT YOUR LOCAL EMERGENCY NUMBER IMMEDIATELY.

IMPORTANT DISTINCTION

This document is not a treatment consent, surgical consent, anesthesia consent, or informed medical consent. It does not authorize Aesthetica Medical Travel, LLC (“Aesthetica”) to practice medicine or make clinical decisions.

This document authorizes Aesthetica’s limited operational handling of personal information and health-related information, and its coordination-related communications and administrative support, solely for non-clinical coordination purposes.

All medical treatment consents, clinical consents, surgical consents, anesthesia consents, and treatment decisions remain solely between the patient and the relevant independent provider or facility.

Aesthetica may revise these terms from time to time to reflect legal, regulatory, operational, business, security, or service changes. The version presented at the time of acceptance will govern unless mandatory law requires otherwise.

This document may be incorporated into, or accepted together with, the Aesthetica Patient Purchase Agreement, Order Form, Checkout Summary, or related clickwrap or electronic-signature workflow.

1. Nature of Aesthetica’s Role

Aesthetica is a non-clinical coordination company. Aesthetica helps coordinate aspects of the patient journey, including intake, provider introductions, records organization, scheduling support, travel and logistics planning, administrative communications, billing support, and related concierge-style coordination services.

Aesthetica does not practice medicine, does not diagnose, does not prescribe, does not provide treatment, does not provide nursing or hospital services, does not grant medical clearance, and does not make clinical decisions.

All medical advice, teleconsultations, treatment recommendations, informed consent discussions, surgical planning, prescriptions, anesthesia decisions, and clinical judgments are provided solely by independent licensed providers and facilities.

2. Purpose; Limited Operational Authorization

I authorize Aesthetica to collect, receive, review, organize, abstract, summarize, translate, transmit, disclose, and store personal information and health-related information reasonably necessary for non-clinical coordination purposes only.

This authorization is limited to case coordination activities such as:

• provider introductions and matching;
• consultation coordination;
• records collection and transmission;
• scheduling;
• itinerary and logistics planning;
• billing administration;
• translation logistics;
• insurer or payment-related communications;
• post-operative administrative follow-up; and
• administrative response to complications, delays, emergencies, or major travel disruptions.

This authorization does not authorize Aesthetica to diagnose, prescribe, interpret medical data clinically, or make treatment decisions.

3. Categories of Information Covered

I authorize Aesthetica to handle information reasonably necessary for coordination, which may include:

• identity and contact information;
• date of birth;
• passport, travel, and itinerary information;
• emergency contact details;
• companion or caregiver details;
• provider questionnaires;
• photographs and videos;
• medical records and provider notes furnished to Aesthetica;
• laboratory results, imaging, medication lists, allergies, prior surgical history, and disclosed health conditions;
• post-operative updates and incident reports;
• insurance details;
• billing and transaction records; and
• other information reasonably relevant to coordination of my case.

I understand that if I choose not to provide certain information, Aesthetica and/or the independent provider may be unable to proceed with some or all coordination services.

4. Remote Consultations with Independent Providers

As part of Aesthetica’s coordination services, Aesthetica may help arrange remote consultations, including audio, video, or other electronic communications, with independent providers.

I understand and acknowledge that:

• any teleconsultation, virtual consultation, or remote clinical interaction is a service provided solely by the independent provider and not by Aesthetica;
• electronic systems may be used to transmit records, images, forms, and communications for coordination and consultation purposes;
• remote communications may involve risks, including delay, technical failure, poor connection quality, incomplete transmission of records or images, privacy incidents, or misunderstandings caused by incomplete information;
• remote consultation may be insufficient for a provider to determine eligibility, safety, treatment options, or next steps without additional in-person evaluation, testing, imaging, or records;
• no remote consultation guarantees any recommendation, quote, treatment plan, medical clearance, treatment acceptance, or procedure; and
• all questions regarding diagnosis, treatment, safety, recovery, risk, suitability, or outcome must be directed to the independent provider, not to Aesthetica.

5. International Transfer and Cross-Border Handling

I understand that Aesthetica operates in an international setting and that my information may be collected, accessed, transmitted, processed, disclosed, or stored across jurisdictions, including the United States, Brazil, and any other jurisdiction reasonably involved in my case.

I expressly authorize cross-border transfer of personal information and health-related information to parties reasonably involved in my case, including:

• independent physicians;
• clinics and hospitals;
• laboratories, imaging centers, and pharmacies;
• recovery partners and aftercare-related vendors;
• transportation providers and hotels;
• insurers;
• legal counsel;
• payment processors; and
• technology vendors used for case administration.

I understand that privacy, data protection, professional secrecy, record retention, and enforcement frameworks may differ across jurisdictions and may provide rights, procedures, or remedies different from those available in my home jurisdiction.

I further understand that cross-border handling, while operationally necessary, may carry privacy, cybersecurity, interception, misdelivery, or enforcement risks that cannot be completely eliminated.

6. Electronic Communications Consent

I authorize Aesthetica to communicate with me using:

• email;
• telephone;
• voicemail;
• SMS/text;
• WhatsApp;
• secure portals;
• cloud-storage links;
• video call tools;
• electronic signature platforms; and
• other commercially reasonable communication tools selected for coordination convenience.

I understand that some communication channels may involve risks, including interception, delay, misdelivery, metadata exposure, shared-device access, screenshotting, spam filtering, account compromise, or third-party carrier/platform breaches outside Aesthetica’s reasonable control.

I instruct Aesthetica to use my designated communication channels unless and until I revoke or modify that instruction prospectively in writing.

I understand that it is my responsibility to keep my contact information current and to notify Aesthetica promptly if I want certain channels changed or restricted, subject to operational limitations.

7. Emergency, Incapacity, Serious Events, and Death Authorization

If Aesthetica reasonably believes that I have suffered a serious complication, hospitalization, incapacity, disappearance, detention, death, or other major emergency, I authorize Aesthetica to disclose the minimum information reasonably necessary for administrative coordination to:

• my designated emergency contact(s);
• my authorized companion, caregiver, or family member;
• treating providers or facilities;
• hospital administrators;
• insurers;
• consular personnel;
• air or ground transportation providers;
• hotels or recovery accommodations;
• funeral, repatriation, or remains-logistics providers; and
• legal representatives reasonably involved in crisis coordination.

I further authorize Aesthetica to assist administratively with:

• provider communications;
• emergency travel changes;
• insurer notifications;
• repatriation or remains logistics;
• documentation support; and
• related coordination tasks.

I understand that Aesthetica undertakes no duty to finance, guarantee, medically direct, or personally perform these activities.

This authorization survives incapacity and death to the maximum extent permitted by law for administrative coordination, claims handling, repatriation, transport, and legal-compliance purposes.

8. Privacy and Confidentiality Acknowledgment

I understand that Aesthetica will use reasonable administrative, technical, and organizational measures to safeguard my information. However, no system, platform, device, or method of transmission is completely secure.

I understand that Aesthetica’s Privacy Policy governs how personal information is collected, used, disclosed, and safeguarded in connection with the website, platform, and services, and that additional health-information or case-related notices may also apply depending on the workflow and service context.

I further understand that Aesthetica may not be a HIPAA covered entity or business associate in every context, and that independent providers, facilities, and foreign parties involved in my case may operate under different legal and regulatory regimes.

9. Accuracy, Updating Duties, and Revocation

I represent that information I provide to Aesthetica and to independent providers is truthful, complete, and current.

I agree to update Aesthetica promptly regarding any material change, including:

• medication changes;
• pregnancy status;
• nicotine use;
• anticoagulant use;
• recent illness;
• prior complications;
• newly relevant diagnoses; or
• travel restrictions or other material logistical changes.

I understand that I may revoke this authorization prospectively by written notice, but such revocation will not affect:

• prior disclosures already made;
• retention required by law, contract, insurance, payment, or compliance obligations;
• emergency steps already undertaken;
• claims preservation;
• chargeback, payment, or refund administration;
• litigation hold obligations; or
• other acts already reasonably performed in reliance on this authorization.

If I revoke authorizations in a manner that materially impairs Aesthetica’s ability to coordinate my case safely, lawfully, or operationally, Aesthetica may suspend or terminate services.

10. No Guarantee; No Substitute for Medical Advice

I understand that:

• Aesthetica does not guarantee eligibility, provider acceptance, scheduling, medical clearance, treatment availability, outcomes, recovery timing, or patient satisfaction;
• no provider introduction, electronic communication, translated summary, or records coordination by Aesthetica constitutes medical advice;
• translated, summarized, abstracted, or reformatted information may omit nuance;
• Aesthetica is not responsible for clinical interpretation, diagnostic accuracy, or treatment decisions made by independent providers; and
• any medical decision must be made by me and the independent provider.

I also understand that I should promptly disclose complete and accurate information to providers and seek immediate emergency care whenever medically necessary.

11. Payment Authorization and Billing Consent

I understand and agree that Aesthetica may require payment information in order to process membership fees, coordination fees, deposits, add-ons, rescheduling fees, and other charges that I authorize or incur under my accepted Purchase Agreement, Order Form, Checkout Summary, or other applicable service documents.

I authorize Aesthetica and its payment processors to:

• store and process my authorized payment method as permitted by law and processor rules;
• charge amounts that I expressly authorize at checkout or through accepted service documents;
• charge additional amounts that I separately approve in writing or electronically for add-ons, upgrades, change requests, or authorized out-of-scope services; and
• process unpaid balances, failed installments, or reattempted charges to the extent permitted by my accepted payment terms and applicable law.

I understand that:

• Aesthetica fees are generally fees for non-clinical coordination services;
• provider, facility, anesthesia, laboratory, pharmacy, travel, hotel, recovery, aftercare, and other third-party charges may be separate, even if displayed in a single checkout or workflow;
• Aesthetica may use third-party payment processors and may not store full payment card details on its own systems;
• refunds, if any, are governed by the accepted purchase terms, cancellation terms, refund terms, and applicable law; and
• unless clearly disclosed otherwise, no payment constitutes a guarantee of treatment, medical clearance, or provider acceptance.

If a card-on-file or recurring billing feature applies to a particular service, plan, or membership, I understand that such feature must be separately disclosed at or before authorization.

12. Acknowledgments and Limited Release

By accepting this document, I acknowledge and agree that:

• I have read and understood this document;
• I understand that Aesthetica is a non-clinical coordination company and not my doctor, surgeon, hospital, anesthesiologist, or healthcare provider;
• I authorize Aesthetica to collect, receive, review, organize, summarize, translate, transmit, disclose, store, and operationally use my information as reasonably necessary to coordinate my case;
• I consent to electronic communications and understand their risks;
• I consent to cross-border handling and international transfer of my information as reasonably necessary for my case;
• I authorize Aesthetica to contact my emergency contact and other operationally relevant parties if I become unreachable, incapacitated, hospitalized, detained, or involved in a serious event;
• I understand that any teleconsultation or remote clinical interaction is between me and the independent provider, not Aesthetica;
• I understand that no medical result, timeline, or outcome is guaranteed; and
• I understand that my continued use of Aesthetica’s services may constitute my ongoing acknowledgment of these terms, subject to applicable law and any properly presented updated version.

To the maximum extent permitted by law, I release Aesthetica from claims arising out of lawful or reasonably necessary collection, organization, transmission, translation, summary, storage, or disclosure of information consistent with this authorization and the governing purchase agreement, except to the extent finally adjudicated to have resulted solely from Aesthetica’s gross negligence, willful misconduct, or other conduct that cannot lawfully be released.

13. Electronic Acceptance

When deployed in a hosted checkout, intake portal, membership flow, or electronic-signature workflow, this document may be accepted by reference through the same clickwrap or acceptance event as the Aesthetica Patient Purchase Agreement and related case documents.

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