Consent for Testing Agreement

I hereby authorize (i) Nutritional Biochemistry, Inc. (with its affiliates and staff, “NBI”), (ii) Lab Testing API, LTD (with its affiliates and staff, “Lab Testing API”) and (iii) PWN Remote Care Services, (with its affiliates and administrative services provider, “PWN”), including its physicians, their staff, agents and designees, including PWNHealth, LLC, as agent and administrative services provider and the laboratories that perform services requested by or consented by me (“PWN Parties”) to use and disclose health information about me in the manner and for the purposes stated below. This authorization applies to the use and disclosure of the following information...

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