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NAD+ and Peptide Therapy Informed Consent

Thank you for choosing Wellness VIP LLC for your wellness and rejuvenation needs. Please take a few moments to complete this form. The information you provide will help us better understand your goals and needs so we can personalize your experience and provide the best care possible.
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    Privacy Policy


    Effective Date: January 1, 2026

    Wellness VIP LLC (“Wellness VIP,” “we,” “us,” or “our”) is committed to protecting the privacy, confidentiality, and security of personal information and protected health information (“PHI”). This Privacy Policy explains how we collect, use, disclose, and safeguard information obtained through our website, wellness services, telehealth services, and related digital platforms.

    1. Scope of This Policy
    This Privacy Policy applies to:

    Visitors to the Wellness VIP website
    Patients and clients who use our wellness, health, aesthetic, and telehealth services
    Individuals who communicate with us electronically or submit personal or health information
    This policy is intended to comply with applicable U.S. federal and state privacy laws, including the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), where applicable.

    2. HIPAA Compliance and Protection of Health Information
    Wellness VIP LLC is committed to complying with HIPAA and all applicable federal and state laws governing the privacy and security of protected health information (PHI), where applicable.

    We maintain administrative, technical, and physical safeguards designed to protect the confidentiality, integrity, and availability of PHI, including:

    Secure data storage and encrypted communications
    Access controls that limit information to authorized personnel
    Appropriate electronic systems and service providers
    Policies and procedures designed to prevent unauthorized access, disclosure, or misuse of health information
    Third-party vendors or service providers who may have access to PHI on our behalf will be required, where applicable, to maintain appropriate privacy and security protections.

    3. Information We Collect
    We may collect the following categories of information:

    a. Personal Information
    Name
    Email address
    Phone number
    Billing and payment information
    Account or login information
    b. Health Information (PHI)
    Medical history
    Health and wellness information
    Intake forms and questionnaires
    Treatment-related information
    Communications with healthcare professionals
    Information necessary to provide services
    c. Technical Information
    IP address
    Browser type
    Device information
    Website usage information
    Cookies and similar technologies
    4. How We Use Information
    We may use collected information to:

    Provide health, wellness, aesthetic, and telehealth services
    Communicate with patients and clients regarding appointments, care, and services
    Process payments and manage accounts
    Coordinate and administer services
    Improve our services, website, and customer experience
    Maintain business and treatment records
    Comply with applicable legal, regulatory, and professional obligations
    We do not sell protected health information.

    5. Disclosure of Information
    We may disclose personal information or PHI, as permitted or required by applicable law, including:

    To healthcare providers and professionals involved in your care
    To service providers assisting with our business operations
    When required by law, regulation, legal process, or court order
    When necessary to protect the health, safety, or legal rights of patients, clients, or others
    For other purposes permitted under applicable privacy laws
    When HIPAA applies, disclosures of PHI will be handled in accordance with HIPAA requirements, including applicable minimum-necessary standards.

    6. Patient Rights Under HIPAA
    Where HIPAA applies, patients may have the right to:

    Request access to their health information
    Request correction of inaccurate or incomplete information
    Request restrictions on certain uses or disclosures
    Request confidential communications
    Receive an accounting of certain disclosures, as permitted by law
    Receive a copy of applicable privacy notices
    Requests may be submitted using the contact information provided below.

    7. Data Security
    Wellness VIP LLC uses reasonable and appropriate administrative, technical, and physical safeguards designed to protect personal information and PHI from unauthorized access, alteration, disclosure, loss, or destruction.

    Although no electronic system or method of transmission can be guaranteed to be completely secure, we take reasonable steps to protect information within our control.

    8. Cookies and Tracking Technologies
    Our website may use cookies, analytics tools, and similar technologies to improve website functionality, understand website usage, and enhance the user experience.

    You may be able to control or disable certain cookies through your browser settings. Disabling cookies may affect some website functionality.

    9. Jurisdiction and Applicability
    This Privacy Policy applies to users and patients located in the United States and other jurisdictions where Wellness VIP LLC lawfully provides services.

    Our privacy practices are intended to comply with applicable federal and state privacy and data protection laws. Additional privacy rights or requirements may apply depending on your location and the services you receive.

    10. Changes to This Privacy Policy
    Wellness VIP LLC reserves the right to update or modify this Privacy Policy at any time. Any changes will be posted on this page with an updated effective date.

    11. Contact Information
    For questions, concerns, or requests regarding privacy or protected health information, please contact:

    Wellness VIP LLC
    Address: 9299 SW 152nd St, Suite 200, Miami, FL 33157
    Phone: 786-732-4742
    Email: wellness.vipllc@gmail.com
    Website: wellnessvipantiaging.com

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    HIPAA NOTICE OF PRIVACY PRACTICES


    Effective Date: January 1, 2026

    This Notice of Privacy Practices (“Notice”) describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

    Wellness VIP LLC (“Wellness VIP,” “we,” “us,” or “our”) is required by law, where applicable, to maintain the privacy of your protected health information (“PHI”) and to provide you with this Notice explaining our legal duties and privacy practices with respect to your PHI.

    1. Our Legal Duties
    We are required by law to:

    Maintain the privacy and security of your PHI
    Provide you with this Notice of our legal duties and privacy practices
    Follow the terms of the Notice currently in effect
    Notify you following a breach of unsecured PHI as required by law
    2. Uses and Disclosures of Protected Health Information
    We may use and disclose your PHI without your authorization for certain purposes permitted by law, including:

    a. Treatment
    We may use and share your PHI to provide, coordinate, or manage your healthcare, wellness, aesthetic, and related services. This may include communicating with healthcare providers involved in your care.

    b. Payment
    We may use and disclose PHI to obtain payment for healthcare and related services provided to you. This may include billing, claims management, payment processing, and other activities necessary to receive payment.

    c. Healthcare Operations
    We may use and disclose PHI for healthcare operations and business activities, including quality assessment, staff training, licensing, accreditation, compliance, auditing, and business administration, as permitted by law.

    3. Other Permitted Uses and Disclosures
    We may disclose PHI when permitted or required by applicable law, including:

    As required by federal, state, or local law
    For public health and safety activities
    To comply with legal proceedings or lawful law enforcement requests
    To prevent or reduce a serious threat to the health or safety of an individual or the public
    To HIPAA-compliant service providers who support our operations and are subject to appropriate contractual confidentiality and security requirements
    For other purposes permitted under applicable federal and state laws
    4. Uses and Disclosures Requiring Your Authorization
    Any use or disclosure of your PHI that is not permitted or described in this Notice will generally be made only with your written authorization, when required by law.

    You may revoke an authorization in writing at any time, except to the extent that Wellness VIP LLC or others have already taken action in reliance on the authorization.

    5. Your Rights Regarding Your Health Information
    Depending on applicable law, you have the right to:

    Access: Request to inspect or obtain a copy of your PHI.

    Amendment: Request an amendment or correction to your PHI if you believe information is inaccurate or incomplete.

    Accounting: Request an accounting of certain disclosures of your PHI.

    Restrictions: Request restrictions on certain uses or disclosures of your PHI.

    Confidential Communications: Request that we communicate with you in a specific manner or at a specific location.

    Copy of This Notice: Request a paper or electronic copy of this Notice at any time.

    Requests must be submitted using the contact information below. Certain requests may be denied as permitted or required by law.

    6. Security of Your Information
    Wellness VIP LLC implements reasonable administrative, technical, and physical safeguards designed to protect your PHI from unauthorized access, use, alteration, or disclosure, in accordance with HIPAA and applicable laws.

    7. Telemedicine and Electronic Communications
    If you use Wellness VIP LLC’s telemedicine or electronic communication services, you acknowledge that certain communications may occur electronically.

    We use reasonable security measures and, where applicable, HIPAA-compliant technology platforms and service providers to protect the privacy and security of your information.

    Electronic communications may carry certain risks, and no electronic system can be guaranteed to be completely secure.

    8. Changes to This Notice
    We reserve the right to change this Notice at any time. Changes will apply to PHI we maintain as permitted by applicable law.

    An updated version of this Notice will be made available through our website and will include the revised effective date.

    9. Complaints
    If you believe your privacy rights have been violated, you may file a complaint with Wellness VIP LLC or with the U.S. Department of Health and Human Services, Office for Civil Rights.

    You will not be retaliated against for filing a privacy complaint.

    10. Contact Information
    For questions, requests, or complaints regarding this Notice or your protected health information, please contact:

    Wellness VIP LLC
    9299 SW 152nd St, Suite 200
    Miami, FL 33157

    Phone: 786-732-4742
    Email: wellness.vipllc@gmail.com
    Website: wellnessvipantiaging.com

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    NAD+ and Peptide Therapy

    These are are advanced treatments designed to support cellular repair, energy metabolism, hormonal balance, and healthy aging. These therapies are offered as part of a personalized wellness plan under the supervision of a licensed provider.

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    Purpose of Treatment

    NAD+ (Nicotinamide Adenine Dinucleotide) therapy helps restore mitochondrial function, improve energy levels, and enhance DNA repair. Peptides such as Sermorelin and GHRP-2 stimulate the natural production of growth hormone, promoting recovery, sleep, body composition, and cognitive function.

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    I understand that a licensed medical provider will review my intake form and medical history to determine if this therapy is appropriate for me. No medication will be prescribed without clinical justification and professional medical judgment.

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     Potential Risks and Side Effects

    Common side effects include nausea, constipation, diarrhea, abdominal discomfort, headache, or fatigue. Serious but rare risks may include pancreatitis, kidney issues, allergic reactions, or gallbladder complications. The medication should be discontinued if you experience persistent severe abdominal pain, vision changes, or signs of dehydration.

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    Monitoring and Follow-Up

    I agree to participate in regular follow-up appointments as recommended by my provider. I understand that labs, vitals, and dosage adjustments may be required for safe and effective treatment.

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    Consent for Treatment

    I have read and understand the above information. I have had the opportunity to ask questions, and all of my questions have been answered to my satisfaction. I voluntarily consent to the use of GLP-1 therapy under medical supervision.

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    Scheduling your consultation allows us to prepare the best care plan tailored to your needs.
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