Electronic Signature Agreement

Consent to Use Electronic Records & Electronic Signatures

Sunshine Mobile Wellness offers the convenience of completing forms, acknowledgments, informed consents, and other documents electronically.

By signing electronically, you agree that your electronic signature is legally binding and has the same legal effect as your handwritten signature.

Electronic Documents

I understand that I may complete and sign documents electronically, including but not limited to:

• Client Intake Forms
• Medical History Questionnaire
• HIPAA Acknowledgment
• Website Privacy Policy
• Website Terms & Conditions
• Financial Policy
• Cancellation & Refund Policy
• Telehealth Informed Consent
• Consent to Treat
• IV Therapy Informed Consent
• NAD+ Therapy Consent
• Vitamin Injection Consent
• Glutathione Add-On Consent
• Emergency Medical Authorization
• Photography & Media Release
• Future wellness consents, acknowledgments, and authorizations as applicable

Electronic Signature

I understand that my electronic signature:

• Has the same legal force and effect as my handwritten signature.
• Confirms that I have reviewed each document before signing.
• Indicates my agreement to the terms contained within each document.
• Becomes part of my permanent medical record when applicable.

Electronic Records

I understand that Sunshine Mobile Wellness maintains electronic records to document:

• Medical history
• Consents
• Treatment documentation
• Communications regarding my care
• Appointment history
• Billing information
• Electronic signatures

These records are maintained in accordance with applicable federal and California laws governing healthcare records.

My Responsibilities

By signing electronically, I certify that:

• I am the individual identified in these records, or I am legally authorized to sign on behalf of the client.
• All information I have provided is true and complete to the best of my knowledge.
• I have had the opportunity to review each document before signing.
• I understand that I may request copies of any signed documents.
• I understand that I should ask questions before signing if anything is unclear.

Consent

By signing below, I acknowledge and agree that:

• ☐ I consent to the use of electronic records.
• ☐ I consent to the use of electronic signatures.
• ☐ I understand my electronic signature has the same legal effect as a handwritten signature.
• ☐ I understand that signed electronic documents become part of my permanent record when applicable.
• ☐ I certify that I have reviewed the documents presented to me before signing.
• ☐ I understand that I may request copies of any documents I electronically sign.

Electronic Signature

Client Name: ______________________________________

Date of Birth: _____________________________________

Email Address: _____________________________________

Electronic Signature: ________________________________

Date: _____________________________________________

Sunshine Mobile Wellness Certification

Sunshine Mobile Wellness maintains electronic records and signatures in accordance with applicable federal and California laws. Electronic records are protected through administrative, physical, and technical safeguards designed to maintain confidentiality, integrity, and security.