Informed Consent

In the event that the company proceeds with the reorganization, sale, lease, merger or amalgamation or any other type of disposal or financing of the company or a portion of the company or of any of the business or assets of the company, the company shall comply with the requirements set out in subsection 20(3) of the Personal Information Protection Act (British Columbia).

The company may collect, use, share and access different types of information or data about the company’s clients and/or patients in such ways that do not identify such individuals directly (e.g. by name) or indirectly (e.g. by date of birth) and for statistical purposes only. Such information may include personal characteristics or other information about which an individual has a reasonable expectation of privacy (e.g., age, ethnicity, health history, life experience, social status). The company does not release any information that could identify individuals without their consent. The company covenants that all personal information (within the meaning attributed thereto in applicable legislation in British Columbia) of or with respect to the patients shall only be used, disclosed or dealt with in strict compliance with applicable privacy legislation.

Who has Access to Information Collected?

We strictly control access to your personal information to our employees who need this information in order to serve you or to employees who analyze our performance in order to measure and improve our services. Employees are kept up-to date with regard to the privacy and security practices of Rejuva Research.

We reserve the right to co-operate with local, provincial and national officials in any investigation requiring either personal information including any personal information provided online or reports about lawful and unlawful user activities on the Web site.

If you ask us, we will remove any information about you from our files, unless some legitimate purpose makes its reasonable for us to retain it for some additional time. We will also review our files from time to time with a view to identifying and deleting stale information.

Risks of using electronic communication

Rejuva Research has offered to communicate using the following means of electronic communication (“the Services”): Email, VideoConferencing, Text messaging

Rejuva Research will use reasonable means to protect the security and confidentiality of information sent and received using the Services. However, because of the risks outlined below, the Physician cannot guarantee the security and confidentiality of electronic communications:

Use of electronic communications to discuss sensitive information can increase the risk of such information being disclosed to third parties. Despite reasonable efforts to protect the privacy and security of electronic communication, it is not possible to completely secure the information.

Employers and online services may have a legal right to inspect and keep electronic communications that pass through their system.

Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings.

Electronic communications can be forwarded, intercepted, circulated, stored, or even changed without the knowledge or permission of the Physician or the patient.

Even after the sender and recipient have deleted copies of electronic communications, back-up copies may exist on a computer system.

Electronic communications may be disclosed in accordance with a duty to report or a court order.

Videoconferencing using services such as VSee or Zoom may be more open to interception than other forms of videoconferencing.

Email, text messages, and instant messages can more easily be misdirected, resulting in increased risk of being received by unintended and unknown recipients.

INFORMED CONSENT

By signing this document, you acknowledge that you have been informed of and understand the following:

The physicians, the clinic staff, and/or clinic representatives are neither providing nor dispensing the medical cannabis.

The physician or clinic staff will NOT be providing or discussing information regarding any other way of obtaining medical cannabis other than from a Health Canada approved licensed producer.

The physicians are evaulating you for the use of medical cannabis and will make their recommendation based in part, on the medical information you have provided. It is your responsibility to ensure that there is no misrepresentation of your medical information submitted in order for you to obtain a recommendation to use cannabis for your medical condition.

You agree to only use medical cannabis for the treatment of your medical condition as agreed upon by the physician and not for recreational or non-medical purposes.

The physician is addressing specific aspects of your medical care and, unless otherwise stated, is in no way establishing herself as your primary care physician.

Should the physician approve you for the use of medical cannabis, it is your responsibility to ensure that a renewal appointment is made one month prior to your expiry date. During your renewal appointment the physician will re-evaulate the possible continuance of cannabis.

You understand that it is your responsibility to stay informed regarding provincial and federal laws regarding the possession, use, sale/purchase and/or distribution of medical cannabis.

Health Canada, the physicians and the Rejuva Research staff advise you that using cannabis is prohibited while driving or performing hazardous tasks such as operating heavy machinery. The same applies to safety-sensitive occupations such as health professionals and the supervision of children. Depending on dosage and administration, impairment can last over 24 hours following last usage.

The potential side effects from the use of cannabis include, but are not limited to the following; dizziness, anxiety, confusion, sedation, low blood pressure, impairment of short-term memory, euphoria, difficulty in completing complex tasks, suppression of the body’s immune system, inability to concentrate, impaired motor skills, paranoia, psychotic symptoms, general apathy, depression and/or restlessness.

Cannabis may exacerbate schizophrenia in persons predisposed to the disorder.

Cannabis use may cause exessive talking and eating, alter your perception of time and space and impair your judgement.

You understand that using cannabis while under the influence of alcohol is not recommended. Additional side effects may become present when using both alcohol and cannabis.

Smoking cannabis may cause respiratory problems and harm, including; bronchitis, emphysema and laryngitis. In the opinion of many researchers, cannabis smoke contains known carcinogens (chemicals that cause cancer) and smoking cannabis may increase the risk of respiratory diseases and cancers in the lung, mouth, and tongue. In addition, cannabis smoke contains harmful chemicals known as tars. If you begin to experience respiratory problems when using cannabis, you agree to stop using it and report your symptoms to a physician.

The physicians and/or the Rejuva Research staff will inform you of alternatives to smoking cannabis.

The risk, benefits and drug interactions of cannabis are not fully understood. If you are taking medication or undergoing treatment for any medical condition, you understand that you should consult with your primary care physician(s) before using cannabis and that you should not discontinue and medication or treatment previously prescribed unless advised to do so by your primary care physician.

Individuals may develop a tolerance to and/or dependence on cannabis. If you develop signs of withdrawal, which can include; feelings of depression, sadness, irritability, insomnia, restlessness, agitation, loss of appetite, trouble concentrating, sleep disturbances, and unusual tiredness, contact the Rejuva Research.

Symptoms of cannabis overdose include but are not limited to; nausea, vomiting, hacking cough, disturbance in heart rhythm, numbness in hands, feet, arms or legs, anxiety attacks and incapacitation. If you experience these symptoms, you agree to contact your primary care physician, call 911 or go to the nearest emergency room.

If the Rejuva Research subsequently learns that the information you have furnished is false or misleading, the recommendation by the physician for cannabis may be revoked. You agree to promptly meet the Rejuva Research and/or provide additional information in the event of any inaccuracies or misstatements in the information you have provided.

Recommendations made by the Rejuva Research about Licensed Producers, strains and methods of intake are recommendations ONLY. The Rejuva Research reserves the the right to discuss your information with your licensed producer and you agree with your licensed producer sharing information about your application and recommendation with the Rejuva Research.

If you do not understand any of the above, you agree to contact the Rejuva Research for clarification.

The Rejuva Research is a private clinic that charges a fee for service. The clinic has a 7 day cancellation policy. Failure to cancel your appointment within the 7 days will result in a $200.00 charge. To cancel an appointment, you must speak directly with one of the clinics medical office assistants. Cancellations by email or phone message will not be accepted.

I authorize any Rejuva Research physician to make direct contact with a current, treating primary care physician to determine whether excessive use of cannabis has harmed myself, the patient.

I understand that the information I have been asked to provide to the Rejuva Research and/or the Physician is for the diagnosis and treatment of the medical condition(s) for which I want to access medical cannabis. I understand that if I have not accurately and completely disclosed the requested information, it may adversely impact the physician’s ability to diagnose my condition and recommend appropriate medical cannabis treatment.