INFORMED CONSENT DOCUMENT AGREEMENT TO BE IN A RESEARCH STUDY

Challenge/Study Title	Introduction
Challenge Coach (The Person in Charge of This Research Study)	Efforia Advanced Author
Sponsor	This study is made possible by your payment to join.
Challenge Cost	$0
Included Products & Services
Outcome Measures
Contact	help@efforia.com

The Purpose of This Study

The study aims to explore, understand, and analyze the impact of interactive and engaging activities on the overall well-being and mental health of individuals. It is designed to uncover the potential benefits and drawbacks of such activities and their influence on stress levels, happiness, and overall life satisfaction. Additionally, the study hopes to offer insights that could help in creating more effective and personalized wellness strategies. Your participation will contribute to a broader understanding of these factors.

Your Responsibilities as a Participant

The study is best suited for individuals who are interested in self-improvement, personal growth, and mental health. As a participant, you are expected to engage in the activities provided, provide honest feedback, and maintain regular communication with the research team. Your participation is completely voluntary, and you have the right to leave the study at any time. However, refunds are not available once you've joined.

Your Rights as a Participant

Participation in this study is completely voluntary, and you may drop out at any time. It's important to note that refunds are not available once you've joined the study. Your decision to participate, decline, or withdraw will not affect your relationship with Efforia or the respective sponsors. You are entitled to ask questions and receive answers about the study.

How to Leave the Study

To leave the study, go to your Profile page, click “Your Challenges” and click “leave.” Please remember your join fee is not refundable. This payment is important to keep the study experience sound for other participants.

Risks and Benefits

Participation in this study may bring about feelings of discomfort as you may be asked to answer questions that require introspection and self-evaluation. If you feel distressed or suicidal at any point, we urge you to contact the National Suicide Prevention Hotline by dialing 988. While the study aims to provide valuable insights and potentially beneficial strategies, it is not a substitute for professional medical advice or treatment. We encourage you to consult with a medical professional or life coach if you have any concerns or questions. Please note, this study does not provide a medical diagnosis or cure, and some insurance plans may not cover injuries or adverse events related to participation in a research study.

What to do if you have an adverse event or medical emergency

If you experience any adverse event or medical emergency, seek immediate help from your local healthcare provider. Do not attempt to contact Efforia, the community, or study sponsors until after you've sought care. Once you've received medical attention, please report any adverse events to help@efforia.com.

Data Protections

During this study, we will collect data related to your participation, including your responses and feedback. This data will be used to provide personalized outcome reports, reminders, and overall findings. Your data will be stored securely and will only be accessed by individuals you have given explicit permission to. You have the freedom to adjust your communication preferences to a level that you are comfortable with. We encourage you to review Efforia's Terms & Conditions and Privacy Policy for more information.

If you have questions

If you have any questions, please don't hesitate to engage with our community. Should you prefer a more private conversation, contact us directly at help@efforia.com.

California Experiential Research Subject’s Bill of Rights

The California Experiential Research Subject’s Bill of Rights protects your rights as a research participant. It assures you the right to be informed of the nature and purpose of the experiment, the procedures to be used, and the potential benefits to be expected. It gives you the right to withdraw from the research at any time without penalty.

HIPAA Waiver

By participating in this study, you waive your rights under the Health Insurance Portability and Accountability Act (HIPAA) to the extent that your data collected during the study may be used for research purposes. This waiver does not affect your rights to healthcare outside of this study.

1. Authorization and Consent for Diagnostic Testing

1. I voluntarily consent and authorize CWI Physician Partners P.C., a California professional corporation; CWI Physician Partners P.C., a Hawaii professional corporation; CWI Physician Partners P.C., a Georgia professional corporation; CWI Physician Partners P.C., a Kansas professional corporation; CWI Physician Partners P.C., an Oregon professional corporation; CWI Physician Partners P.C., a Nevada professional corporation, CWI Physician Partners P.C., a Rhode Island professional corporation; CWI Physician Partners P.C., an Oklahoma professional corporation, as applicable ("CWI") to review the collection, testing, and analysis for the purposes of a diagnostic screening test. I understand that there are risks and benefits associated with undergoing a diagnostic screening testing and there may be a potential for false positive or false negative test results. I assume complete and full responsibility to take appropriate action with regards to my test results. Should I have questions or concerns regarding my results, or a worsening of my condition, I shall promptly seek advice and treatment from an appropriate medical provider. I further acknowledge the following:
   1. I am the individual who will provide the sample for the Test(s) that I am requesting or I am the parent or legal guardian of a minor who is providing the sample for testing.
   2. I am at least eighteen (18) years of age or I am the parent or legal guardian of a minor who is providing the sample for testing.
   3. I have read and understand the information provided about the Test(s) that I have been provided on the website where I requested the Test.
   4. The information I have provided in connection with my request to CWI is correct to the best of my knowledge. I will not hold CWI or its employees or agents responsible for any errors or omissions that I may have made in providing such information.
   5. My health information and results may be shared with CWI employees and agents for the purpose of ordering, processing, and reporting my results.
   6. Medical Services provided by CWI are purely for diagnostic assistance purposes and do not create a physician-patient relationship, and do not constitute medical care or diagnosis or treatment of any condition, disease, or illness.
   7. I authorize CWI to contact me via text message to communicate with me regarding my test.

1. Patient Rights and Privacy Practices
   1. Notice of Privacy Practices and Patient Rights: CWI Notice of Privacy Practices describes how it may use and disclose your protected health information for other purposes that are permitted or required by law. To review a copy of CWI Notice of Privacy Practices, go to http://www.CynergyWellness.com.
   2. Disclosure to Government Authorities: I acknowledge and agree that my test results and associated information may be disclosed to appropriate county, state, federal, or other governmental and regulatory entities as may be permitted by law.

1. Release
   1. To the fullest extent permitted by law, I hereby release, discharge and hold harmless, CWI, including, without limitation, any its respective officers, directors, employees, representatives and agents from any and all claims, liability, and damages, of whatever kind or nature, arising out of or in connection with any act or omission relating to my diagnostic test or the disclosure of my test results.
   2. By selecting the ACKNOWLEDGEMENT during the registration process for diagnostic testing, I acknowledge and agree that I have read, understand, and agreed to the statements contained within this form. I have read the contents of this form in its entirety and voluntarily consent to proceed with these procedures.