Get the important part done before you walk in.

Limitless Performance Medicine is committed to protecting the privacy of your protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). We use and disclose your PHI for treatment, payment, and healthcare operations as permitted by law. You have the right to inspect and copy your records, request amendments, request restrictions on certain uses and disclosures, request confidential communications, and receive an accounting of disclosures. Our full Notice of Privacy Practices is available at emergelimitless.com/privacy and a paper copy will be provided at your first visit. Your acknowledgment below confirms you have been offered the Notice and have had the opportunity to review it.

I understand that some of my care at Limitless Performance Medicine may be delivered via telehealth (live video, secure messaging, or telephone). I understand that telehealth involves the electronic communication of my medical information to a physician licensed in my state of residence; that there are alternatives to telehealth, including in-person visits; and that I may withdraw my consent to telehealth at any time. I understand that no recording of any telehealth visit is made without my explicit consent. I understand that the same standards of confidentiality apply to telehealth encounters as to in-person encounters.

I understand that Limitless Performance Medicine operates as a direct-pay practice and does not bill commercial or government insurance. Compounded peptides, hormone therapies, NAD+, and ancillary services are paid out of pocket. Membership fees, if elected, are non-refundable after the seven-day review window. I am responsible for the full cost of services rendered, lab fees, and any prescription fulfillment through licensed compounding pharmacies. I have been given the opportunity to ask questions about pricing before signing.

I voluntarily consent to medical evaluation, laboratory testing, and treatment provided by Joshua Hare, DO and the clinical staff of Limitless Performance Medicine. I understand that no specific outcome is guaranteed; that all therapies — including hormone optimization, peptide therapy, NAD+ therapy, and other regenerative interventions — carry risks as well as benefits; and that those risks will be reviewed with me before any specific therapy is initiated. I authorize the release of relevant medical information to compounding pharmacies, laboratory partners, and other treating providers as needed for my care.

If testosterone therapy (TRT) is recommended for me, I understand the following. The TRAVERSE trial (NEJM, 2023), a randomized, placebo-controlled study of more than 5,000 symptomatic hypogonadal men, found no increase in major adverse cardiovascular events with testosterone therapy used as indicated, and in 2025 the FDA removed the boxed cardiovascular warning from testosterone labeling. I also understand that this does not mean the therapy is risk-free: the same evidence base shows small but real signals for atrial fibrillation, venous thromboembolism (blood clots), elevated hematocrit (thicker blood), and increased blood pressure — and the FDA added a blood-pressure warning to the label. Testosterone is appropriate only for men with a confirmed diagnosis of hypogonadism, not for ordinary aging. I understand that Limitless manages these risks through baseline and scheduled monitoring of blood counts and blood pressure, screening for arrhythmia and clotting history, and titration to a physiologic, symptom-resolving level. These risks and benefits have been or will be reviewed with me by Joshua Hare, DO before therapy begins, and I may ask questions at any time.