Supplement & Protocol Monitoring Agreement
CLIENT SUPPLEMENT AND PROTOCOL MONITORING AGREEMENT
Kanaklyx LLC
This Compliance Agreement (“Agreement”) is entered into between Kanaklyx LLC (“Provider”) and the undersigned client (“Client”). This Agreement establishes guidelines regarding supplement use and outside product use during the Client’s selected program to support safety, effectiveness, and responsible use.
REGULATORY STATUS
- Some compounds and applications may be considered off-label.
- Off-label application is for research purposes only and not made for human consumption.
1. DEFINITIONS
For purposes of this Agreement:
- “Program” refers to the wellness, performance, or peptide-related protocols provided by Kanaklyx LLC.
- “Supplements” include vitamins, minerals, herbs, amino acids, and other substances intended to supplement the diet.
- “Outside Products” refer to any supplements or compounds not specifically approved or documented by Kanaklyx LLC as part of the Program.
2. CLIENT ACKNOWLEDGMENTS AND RESPONSIBILITIES
The Client agrees to:
- Disclose all current supplements and substances before starting the Program.
- Notify Kanaklyx of any new supplement or compound introduced during the Program within 72 hours.
- Consult Kanaklyx before starting any new over-the-counter supplement or compound.
- Submit to periodic testing if requested to monitor safety and adherence.
- Recognize that failure to disclose Outside Products may compromise the effectiveness and safety of the Program.
3. PROVIDER RESPONSIBILITIES
Kanaklyx LLC agrees to:
- Review disclosed supplements and substances for potential interactions or contraindications.
- Document approved supplements and substances in the Client’s program file.
- Provide clear written instructions regarding supplement and protocol guidelines.
- Establish a process for urgent approvals when reasonably necessary.
4. EXTERNAL CARE COORDINATION
- In urgent situations, the Client may seek outside care without prior notice.
- The Client must notify Kanaklyx of any urgent outside care as soon as reasonably possible.
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If an outside professional recommends a new compound or supplement, the Client agrees to:
- Inform that professional about participation in this Program.
- Notify Kanaklyx within 72 hours about the new recommendation.
5. PRIVACY AND CONFIDENTIALITY
- Kanaklyx LLC will maintain confidentiality of Client information.
- The Client authorizes coordination communications when necessary for safety.
6. TERM AND TERMINATION
- This Agreement becomes effective on the date of signing and remains in effect for the duration of the Program, not to exceed one year without renewal.
- Either party may terminate this Agreement with written notice.
- Kanaklyx may terminate the Agreement immediately if the Client intentionally violates its terms or engages in unsafe behaviors.
- Termination of this Agreement may result in discontinuation of the Program.
7. VOLUNTARY CONSENT AND RIGHT TO WITHDRAW
- The Client acknowledges that participation in this Agreement is voluntary.
- The Client has the right to withdraw consent at any time via written notice.
- Withdrawal may result in modification or termination of the Program.
MEDICAL DISCLAIMER
- All treatments are provided based off of client evaluation.
- Individual results vary and results are not guaranteed.
- Always consult your own physician before administering any peptides.
Client Name (Printed)
Client Signature
Date
Kanaklyx Representative Name (Printed)
Kanaklyx Representative Signature
Date