INDIVIDUAL CONSENT & RELEASE AGREEMENT

By signing this Individual Consent & Release Agreement (the "Agreement"), I hereby grant to Function Health Inc. ("Function") and its subsidiaries, parent companies, branches, licensees, transferees, successors, assigns, designated third-parties, and other affiliates (collectively, Function's "Affiliates"), absolutely and irrevocably, all right, title, and interest in and to any and all text, photographs, images, portraits, pictures, audio content, video content, and/or audiovisual content submitted by me in connection with the below-referenced testimonial (collectively, the "Material") -- including without limitation all protected health information and all other personal information included in the Material -- as well as my name, voice, age, city/state of residence, occupation, image and likeness (collectively, my "NIL") in connection therewith.

Without limitation, I hereby grant Function and its Affiliates the rights to: (a) copyright the Material, in whole or in part, in the name of Function and/or its Affiliate(s); (b) use, copy, reproduce, adapt, translate, sell, modify, edit, distribute, syndicate, publish, transfer, assign, convey, communicate, display, exhibit, commercialize, advertise and/or market in connection with, create derivative works from, and/or otherwise exploit (collectively, to "Use") the Material, in whole or in part, individually or in conjunction with other any other materials, in any and all media now or hereafter known or developed, throughout the entire world, and for any purpose whatsoever, without restriction as to alteration -- including without limitation for the purposes of (i) public relations, (ii) training and education, (iii) advertising, (iv) research, and/or (v) sales and marketing activities (collectively, the "Common Purposes"); and (c) Use my NIL, in whole or in part, in connection with the Material, including without limitation for the Common Purposes.

To the extent that I retain ownership of any Material or any element(s) thereof, then to the fullest extent allowable, I hereby exclusively, irrevocably and unconditionally assign to Function all right, title and interest I may have in and to such Material and any other works now or hereafter created containing such Material, including without limitation, all copyrights (including all extensions and renewals thereof), trademarks, neighboring rights, and any and all ownership and exploitation rights therein now or hereafter recognized, throughout the universe, in perpetuity, in all media now known or hereafter devised. To the extent that any applicable law or agreement prohibits, restricts, or limits the assignment specified in the prior sentence, I hereby grant Function an unlimited, irrevocable, perpetual, worldwide, royalty-free, license to Use the Material throughout the universe, in all media now known or hereafter devised, including without limitation for the Common Purposes.

I hereby waive all of my rights to inspect the finished product arising out of and/or relating to the Material, the Use of such finished product, and/or any other material used in connection such finished product. I further waive any and all claims for compensation arising out of and/or relating to any Use of the Material or my NIL by Function, its Affiliates, and/or their respective executives, directors, officers, employees, attorneys, agents, and/or other representatives (collectively, a person's "Representatives").

I acknowledge and agree that Function has no obligation to Use any of the Material, in whole or in part, for any purposes whatsoever.

I hereby waive any and all rights to and release and discharge Function, its Affiliates, and each of their respective Representatives and from any and all debts, obligations, liabilities, claims, demands, controversies, causes of action, suits, disputes, proceedings, and other legal actions, and any related damages (including, without limitation, actual, consequential, liquidated, punitive, and compensatory), awards, fees (including reasonable outside attorneys' fees and expert fees), costs, expenses, losses, and penalties of every kind whatsoever (collectively, "Liabilities") arising out of and/or relating to: (a) Use or non-Use of the Material, including without limitation any and all Liabilities based upon invasion of privacy, libel, defamation, or rights of publicity; and (b) Use or Non-Use of my NIL in connection with the Material, including without limitation any and all Liabilities relating to the taking, recording, filming, editing, licensing, and/or sale, of my NIL, in whole or in part. The waivers, releases, and discharges specified in this paragraph shall inure to the benefit of Function, its Affiliates, its Representatives, and to each of their respective heirs, legal representatives, licensees, transferees, successors, and assigns.

I acknowledge and agree that this Agreement shall be governed and construed in accordance with the laws of the State of Texas, irrespective of any conflict of laws provisions. I hereby consent to the personal and exclusive jurisdiction and venue of the state and federal courts located in or otherwise closest to Austin, Texas in connection with any claims, demands, controversies, causes of action, suits, disputes, proceedings, and other legal actions arising out of and/or relating to this Agreement.

I acknowledge and agree that, if a court or other body of competent jurisdiction finds any provision of this Agreement, or portion thereof, to be illegal, inapplicable, unenforceable, non-executable, or otherwise invalid, such provision will be limited or eliminated to the minimum extent necessary, so that this Agreement shall otherwise remain in full force and effect and remain enforceable -- and said ruling will not affect any other provision set forth in this Agreement, will not extend beyond its jurisdiction, and will not render such provisions in this Agreement invalid, inapplicable or non-executable.
I acknowledge and agree that Function may freely assign this Agreement and any and all rights, titles, interests, and licenses granted to Function by this Agreement.

I declare that I: (a) am eighteen (18) years of age or older; (b) have an unencumbered right to contract with respect to all Material and my NIL; (c) have no pre-existing obligation that would conflict with this Agreement; (d) am legally competent to execute this Agreement; (e) have carefully read this Agreement; (f) received a reasonable opportunity to ask questions about and negotiate this Agreement; and (g) fully understand the contents hereof. I acknowledge and accept that the terms of this Agreement are contractual and not a mere recital, and that this Agreement is legally binding on me and my heirs, successors, legal representatives and assigns.

AUTHORIZATION TO USE AND DISCLOSE MEDICAL INFORMATION FOR MARKETING PURPOSES

Applicable law gives you certain rights related to your medical information, including the right to know who will receive the information and how it will be used. This Authorization to Use and Disclose Medical Information for Marketing Purposes ("Authorization") permits the disclosure of your medical information by Function Health, Inc. ("Function") as described below.

I authorize Function to use/disclose certain medical information of mine as described below.

I specifically authorize Function to publish the following medical information of mine: my first name; my age; my city/state of residence; my employer, job type, and job title; my marital status; my likeness, voice, and/or other personal characteristics contained in a photograph, video, audio, or any other type of digital media; my self-reported medical information (e.g., age, gender, height/weight, blood type, prior illness); the type of health care services I received from Function; my laboratory test results; information regarding a specific medical condition and/or diagnosis; any other statements made by me specifically regarding my health as it relates to Function Health and/or my laboratory results, including but not limited to such statements appearing in a set of written responses to questions, an interview, a recording, an article, and any other media feature with and/or about me. (collectively, the "Information").

Function may publish the Information on its Internet websites, brochures, advertisements, periodicals, promotional emails, products, broadcasts, slideshow presentations, social media account -- and in other materials and or media -- in connection with publicizing, promoting, advertising, and marketing Function in any manner or form throughout the world. I understand that once disclosed by Function, the Information will no longer be protected by applicable privacy laws.

I understand that I may refuse to sign this Authorization and my treatment, payment, enrollment, or eligibility for benefits will not be affected by or conditioned upon this Authorization.

I further understand that I may revoke this Authorization at any time. My revocation must be in writing, signed by me or on my behalf, and delivered to Function at: [316 West 12th Street, Floor 6, Austin, TX 78701]. I understand that my revocation will be effective only upon receipt, but will not be effective to the extent that Function has already acted in reliance upon this Authorization.

This Authorization will remain in effect indefinitely, unless I revoke it sooner, as described above.

I agree that this Authorization is supplemental to -- and shall in no way replace, revoke, limit, minimize, counteract, diminish, or otherwise restrict -- the Individual Consent and Release Agreement signed by me concurrently with this Authorization; provided, however that this Authorization shall control insofar as a conflict arises between the terms of this Authorization and the terms of the aforesaid Individual Consent and Release Agreement.

I acknowledge and agree that Function may freely assign this Agreement and any and all rights, titles, interests, and licenses granted to Function by this Agreement.

I acknowledge that I have a right to receive a copy of this Authorization.

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