Clinician / Practitioner Verification Form

NeuroField Clinical Use Agreement

This Agreement is entered into by and between NeuroField (“Company”) and the undersigned licensed clinician or healthcare professional (“User”).

This Agreement governs access to and use of NeuroField software and associated neurostimulation devices, including the NeuroField Genesis, Q21, and Photon devices (collectively, the “Products”).

User Attestation

By signing below, the User confirms and agrees to the following:

1. I am a licensed physician, psychologist, or healthcare professional in good standing in my state or jurisdiction.
2. I will use the Products solely within the scope of my professional license and in a clinical setting.
3. I understand that I am responsible for determining the appropriate use of the Products with my patients and for obtaining any necessary informed consent.
4. I will supervise all use of the Products and take full professional responsibility for their clinical application.
5. I agree to indemnify and hold harmless NeuroField, its officers, employees, and affiliates from any claims or liabilities arising from my use of the Products.