Acoustic Pressure Wave Treatment (APWT) is a non-invasive, elective, medical treatment designed to treat the underlying pathophysiology of Erectile Dysfunction (ED) and to generate new blood vessels in the existing vascular bed of the male genitalia. A preliminary consultation is performed to asses the patient’s overall health status and to determine the likelihood ratio of positive results. This initial consultation is free of charge unless otherwise disclosed. Results of the procedure may vary due to the existing anatomy of each individual and the variability that naturally exists among a diverse population. Furthermore supplemental therapy from different medical avenues may be recommended adjunctive to the APWT therapy. These are suggested in accordance with the consulting physician’s expertise and scope of care. All procedures are voluntary and must be approved prior to patient consent. This document serves as the aforementioned “Consent to Treat”.

CONSENT:

I the undersigned, give full consent and authority to Adonis Medical Clinic and the employed staff to provide and perform treatment related to Erectile Dysfunction (ED) and/or the pathophysiology of the disease through the use of medical treatments including but not limited to: Acoustic Pressure Wave Treatment, pharmaceutical prescriptions, Doppler blood flow testing , etc. I understand that the aforementioned treatments are used solely for the purpose of treating and underlying condition, pathology, or to improve overall health and I defer the use of these treatments to the discretion of the consulting doctor and/or clinic staff. I acknowledge that I am healthy enough for sexual activity and/or moderate exercise. I have been made aware and agree that upon signing this document any costs regarding treatment, procedures or other services received from Adonis Medical Clinic will be considered non-refundable. I acknowledge that this treatment is considered to be elective and coverage by an insurance entity is not guaranteed.

This Release and Waiver of Liability, (“The Release”) releases Adonis Medical Clinic and each successor it assigns, libraries, directors, officers, employees, agents and anyone affiliated thereunto. Now therefore, for good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereby agree as follows.

The Patient understands that he/she is responsible for his/her own insurance coverage in the event of personal injury or illness as a result of services provided by Adonis Medical Clinic.

Waiver and Release:
I, the Patient, for myself and my heirs, executors, administrators and assigns, hereby release, waive, discharge, and hold harmless, Adonis Medical Clinic and it's successors, assigns, libraries, directors, officers, employees and agents from any and all liability, claim and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I receive from Adonis Medical Clinic. I understand and acknowledge that this Release discharges Adonis Medical Clinic from any liability or claim that I may have against Adonis Medical Clinic with respect to bodily injury, personal injury, death, property damage, or any other claim that may result from the services received.

Insurance:
Further, I understand that Adonis Medical Clinic does not assume any responsibility for or obligation to provide me with financial or other assistance or to directly bill my insurance entity or the insurance company I am affiliated with. I may at my own volition request and receive a super-bill upon which I may submit in my insurance for coverage or compensation. I understand and agree that receipt of this super-bill does in no way guarantee coverage by my insurance entity of the services provided me by Adonis Medical Clinic and that any part or portion not paid by said entity is my full responsibility.

Medical Treatment:
I hereby release and forever discharge Adonis Medical Clinic from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment, clinic visit, doctor's visit, emergency room visit, or any other medical services received in connection with any treatment received from Adonis Medical Clinic. I acknowledge that I am participating in the services offered from Adonis Medical Clinic of my own free will and choice and that success in the complete or even partial cure of my erectile dysfunction is not guaranteed and that results may vary between individuals. I hold Adonis Medical Clinic harmless and release it from any claim or liability or claim in the event that my medical results are not to my specifications or expectation when treatment has concluded.

Assumption of Risk:
I understand that the services received from Adonis Medical Clinic may include some risks including but not limited to: bruising, bleeding from friable skin, erections lasting for an extended duration of time, slight to major discomfort and/or tingling sensations in the genital area. I hereby expressly assume risk of injury or harm from such services and take full responsibility for my decisions in regards to this matter. I acknowledge that I have been made aware of these risks and assume full responsibility in the event that they occur, subsequently, I release Adonis Medical Clinic from all liability in the event that these risks occur.

Applicable Law:
Choice of Law, Forum Selection: As a Patient. I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Nevada and that this Release shall be governed by and interpreted in accordance with the laws of the State of Nevada. This Agreement is governed by, and must be, construed in accordance with the laws of the State of Nevada, excluding that body of law applicable to conflicts of law. Should any dispute arise, or relate to, this Agreement, directly or indirectly. those dispute(s) shall be governed by the substantive laws of the State of Nevada, without regard to conflict of laws. Additionally, Patient agrees to the exclusive jurisdiction for deciding any dispute shall be in Las Vegas, Nevada, and Patient shall file any claims in a court of competent Jurisdiction in Clark County, Nevada.

Waiver of Jury Trial:
The Parties agree not to elect a jury trial. The Parties waive any current or future right to a jury trial (with regard to any claim, counterclaim, or other action arising under this Agreement). This waiver of right to jury trial is given knowingly and voluntarily by each party and is intended to encompass any instance under which that right might accrue. Each party is authorized to file a copy of this paragraph in any proceeding as conclusive evidence of his waiver by the other. This provision shall survive the termination of this Agreement.

Class, Collective and Representative Action Waiver:
All covered claims under this Agreement must be brought by the Parties' individual capacity and not as a plaintiff or class member in any purported class, collective or representative proceeding. The Parties expressly waive any right with respect to any covered claims to submit, initiate, or participate in a representative capacity or as a plaintiff, claimant or member in a class action, collective action, or other representative or joint action, regardless of whether the action is filed in arbitration or in court. Claims may not be joined or consolidated in arbitration with disputes brought by other individual(s), unless agreed to in writing by all Parties. Furthermore, if a court orders that a class, collective or other representative or joint action should proceed, such action may only proceed in court, and in no event will such action proceed in arbitration. A party may lawfully seek enforcement of this provision and seek dismissal of class, collective or representative actions or claims.

Savings Clause:
I agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected.

BY SIGNING THIS AGREEMENT, PATIENT ACKNOWLEDGES, REPRESENTS, AND AGREES THAT REPRESENTATIVE HAS CAREFULLY READ AND FULLY UNDERSTANDS ALL OF THE PROVISIONS OF THIS AGREEMENT INCLUDING SPECIFICALLY AND WITHOUT LIMITATION THE CLASS, COLLECTIVE AND REPRESENTATIVE ACTION WAIVER, AND THE RELEASE AND WAIVER OF LIABILITY WILLING AND VOLUNTARILY.