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I consent to engaging in tele-health with Athena Telemedicine Partners as a part of the therapy process and my treatment goals. I understand that tele-health psychotherapy may include mental health evaluation, assessment, consultation, treatment planning, and therapy. Tele-health will occur primarily through interactive audio, video, telephone and/or other audio/video communications. I understand I have the following rights with respect to tele-health:

1. I have the right to withhold or remove consent at any time without affecting my right to future care or treatment, nor endangering the loss or withdrawal of any program benefit to which I would otherwise be eligible.

2. The laws that protect the confidentiality of my personal information also apply to tele-health. As such, I understand that the information released by me during the course of my sessions is generally confidential. There are both mandatory and permissive exceptions to confidentiality including but not limited to reporting child and vulnerable adult abuse, expressed imminent harm to oneself or others, or as a part of legal proceedings where information is requested by a court of law. I also understand that the dissemination of any personally identifiable images or information from the tele-health interaction to other entities shall not occur without my written consent.

3. I understand that there are risks and consequences from tele-health including but not limited to, the possibility, despite reasonable efforts on the part of Athena Telemedicine Partners, that the transmission of my personal information could be disrupted or distorted by technical failures and/or the transmission of my personal information could be interrupted by unauthorized persons. In addition, I understand that tele-health based services and care may not be as complete as in-person services. I understand that if my therapist believes I would be better served by other interventions I will be referred to a mental health professional who can provide those services in my area. I also understand that there are potential risks and benefits associated with any form of mental health treatment, and that despite my efforts and efforts of my therapist, my condition may not improve, or may have the potential to get worse.

4. I understand that I may benefit from tele-health services, but that results cannot be guaranteed or assured. I understand that the use of Skype, FaceTime, GoToMeeting, and Google audio/video systems are not 100% secure and may have issues with wifi connectivity. All attempts to keep information confidential while using these systems will be made but a guarantee of 100% confidentiality cannot be made with inherent issues with these communication systems. Signing this form shows an awareness of these issues and a decision by this client to use these systems for tele-health services. I will not hold Athena Telemedicine Partners or its staff liable for gathering or use of client information by these service providers.

5. I understand I have the right to access my personal information and copies of case notes. I have read and understand the information provided above. I have discussed these points with my therapist, and all of my questions regarding the above matters have been answered to my approval.

6. By signing this document, I agree that certain situations including emergencies and crises are inappropriate for audio/ video/ computer based psychotherapy services. If I am in crisis or in an emergency I should immediately call 911 or go to the nearest hospital or crisis facility. By signing this document, I understand that an emergency situation may include thoughts about hurting or harming myself or others, having uncontrolled psychotic symptoms, if I am in a life threatening or emergency situation, and/or if I am abusing drugs or alcohol and are not safe. By signing this document, I acknowledge I have been told that if I feel suicidal I am to call 911, local county crisis agencies or the National Suicide Hotline at 1-800-784-2433.

1. Assumption of Risk: The undersigned customer ("Participant") of Exalted Warrior Foundation is aware that participation in yoga may result in accident or injury. Participant assumes all risks connected with participation in yoga, representing that the participant is in good health and suffers from no physical impairment which would limit the use of Exalted Warrior’s facility.

2. No Medical Services Provided: Participant acknowledges and is aware that Exalted Warrior Foundation has not and will not render any medical services, including medical diagnosis of the participant's physical condition.

3. Release, Waiver, and Covenant Not to Sue: In consideration of being permitted to participate, the participant releases for him/herself and his/her personal representatives, heirs, and next of kin, and hereby releases, waives, discharges, and covenants not to sue Exalted Warrior Foundation, its officers and members, instructors, owners, and lessees of the premises, and each of their officers and employees (collectively referred to as "Releasees"), from all liability to the participant and any claim or damage therefor on account of injury to the person or property, or resulting in the death of the participant, whether caused by the negligence of the Releasees or otherwise, while the participant is participating in yoga.

4. Indemnification: Participant agrees to indemnify the Releasees and each of them from any loss, liability, damage, or costs the Releasees may incur due to the presence of the participant in or around Exalted Warrior Foundation, whether caused by the negligence of the Releasees or otherwise.

Indemnification. The Customer agrees to indemnify, defend, and hold harmless WatchDawg, its affiliates, and their respective officers, directors, employees, and agents from and against any and all claims, damages, liabilities, losses, costs, and expenses (including reasonable attorneys’ fees) arising out of or related to: (a) the Customer’s use or misuse of the WatchDawg platform, services, software, or any integrated data‑collection workflows; (b) any violation of this Agreement by the Customer; (c) any data, content, or materials submitted, transmitted, or processed through WatchDawg by the Customer; or (d) any claim alleging that the Customer’s actions infringed, misappropriated, or violated the rights of a third party.

Product‑Liability Carve‑Out. For clarity, WatchDawg does not manufacture, control, or warrant the performance, safety, or regulatory compliance of any third‑party hardware or software devices used in connection with the WatchDawg platform, including but not limited to Verizon‑supplied mobile phones and Samsung smartwatches used to acquire or transmit patient data. WatchDawg shall have no liability whatsoever for any hardware defects, malfunctions, failures, battery issues, connectivity issues, sensor inaccuracies, or any other product‑liability matters arising from such devices.

Product Liability Carve-Out. For clarity, WatchDawg does not manufacture, control, or warrant the performance, safety, efficacy, or compliance of any third-party pharmacy and/or nutraceuticals used in conjunction with the WatchDawg platform, including but not limited to licensed pharmacy supplied compounded Low Dose naltrexone with methocarbamol (LDX) drug or nutraceuticals such as terpene formulations, THC, CBD, CBN, or CBG supplies and suppliers, used to treat participants under the care of the WatchDawg program and team. WatchDawg shall have no liability whatsoever for any consumable defects, malfunction, failures, formulation assurance/concentration errors, drug interactions, inaccuracies or any other product liability matters arising from such consumables supplied.

The Customer agrees that any claims, damages, injuries, or losses arising from or related to the performance, malfunction, or failure of these third‑party devices and supplied pharmacy and nutraceuticals as appropriate shall be the sole responsibility of the applicable manufacturer, carrier, supplier, or vendor, and the Customer shall not assert such claims against WatchDawg.

WatchDawg reserves the right, at its own expense, to assume the exclusive defense and control of any matter subject to indemnification, and the Customer agrees to cooperate fully in such defense.