‍Why are you being asked to provide this Authorization for Use of Medical Information?

At Function, we want to be sure you understand how the personal information you entrust us with may be used. As we get to know our members better, Function Health, Inc. and its corporate affiliates (together, “Function”) occasionally may want to contact you about products and services that we believe are relevant to you based on your medical information. For example, if you receive lab test results that may indicate an elevated heart risk, Function might contact you about the benefits of an at-home heart monitor with a link to purchase. To ensure we contact you in a way that matches your approved marketing preferences, we ask that you execute this Authorization for Use of Medical Information (“Authorization”). If you choose not to execute this Authorization, we will still provide our services to you the same way we do now.

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(Effective August 6, 2025)

I authorize Function Health, Inc., and its corporate affiliates, including Ezra AI, Inc. (collectively, “Function”) to use my medical information for the purposes listed below. Failing to provide all information requested may invalidate this Authorization.

What does medical information include? My Authorization applies to the following types of information: all of my individually identifiable medical information received, collected or otherwise processed by Function. This medical information may include, without limitation: my name, birthdate, contact information (such as e-mail, address, phone number), demographic information, and any other information pertaining to my medical history, mental or physical condition, or treatment.

What is the purpose of this Authorization? The purpose of this Authorization is to permit Function to: use the information listed above in connection with marketing, advertising, research, and promotional activities by Function regarding: (a) the release, availability, details, specifications, features, quality, performance, and/or price of one or more products, programs, courses, services, and/or opportunities offered by Function and/or a third-party; and/or (b) news, current events, research, history, and advances in science, health, wellness, nutrition, personal care, and/or technology for the purposes of notifying me of opportunities, products, services, and other offerings that Function deems may be of interest to me. Function may also make the information listed above available to its affiliates for the same purposes.

Having fully read the above, I understand that:

Any use or disclosure of individually identifiable medical information carries the potential for unauthorized re-disclosure. Such redisclosure is in some cases not prohibited by applicable laws and may no longer be protected. Applicable laws may prohibit the recipient of my medical information from making further disclosures unless the recipient obtains another authorization from me or unless such disclosure of medical information is required or permitted by applicable law.

I or my designated representative may revoke this Authorization at any time. My revocation must be in writing, signed by me or on my behalf, and delivered to Function via email at the following email address hello@functionhealth.com. My revocation will be effective upon Function’s receipt but will not be effective to the extent that Function or others have acted in reliance upon this Authorization (i.e., prior uses or disclosures will still be valid under the previous Authorization).

I have a right to receive a copy of this Authorization. I may inspect or obtain a copy of the medical information used or disclosed subject to this Authorization.

Function may not condition its provision of services on the receipt of this Authorization.Unless otherwise revoked by me or my designated representative, this Authorization shall be effective for five (5) years from the date of my approval.

I have read and understand the above disclosures and statements. I authorize the use of my medical information as described in this Authorization.