Terms - Gaya Wellness

GAYA TERMS

Gaya Wellness PLLC Terms And Conditions

Terms and Policies

These Terms of Use and Privacy Policy (“Terms”) tell users (“You” or a “User”) terms on which You are permitted to use Our website http://www.gayawellness.org (“Site”). You should read these Terms carefully. By using the Site, You agree to comply with these Terms. If You do not agree with these Terms, You must not use the Site. By using the Site, You agree not to solely rely on the Site in any way for medical treatment and agree to waive any and all potential liability associated with the use of the Site.

IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, PLEASE CALL 911.

Information About the Site; Copyright

The Site is operated by Gaya Wellness, PLL and its affiliates and subsidiaries (“Gaya Wellness” or “we” or “us”). The Site and information contained on the Site is protected by copyright and other intellectual property rights. You may not create modified versions of the content of the Site, or copy the Site, without Our prior written permission. You may not use information from the Site for commercial purposes without permission.

General

This Site provides educational materials related to Your health care journey and allows You to schedule appointments and communicate with Gaya Wellness. Gaya Wellness is the provider of access to the Site. The purpose of this Site is to provide support to Gaya Wellness patients throughout their care with Gaya Wellness providers. We provide fully integrated health care for patients, including nutrition, mental health and wellness, and gynecological care, as well as classes and events. This Site may be used to communicate with Your Gaya Wellness care team during regular business hours, schedule appointments.

Any protected health information You share is protected by and subject to Our HIPAA Policy

Not Medical Advice

The Site is not intended to provide medical advice. The information on this Site is for educational purposes only. The Site has been developed using care and in accordance with existing best practices for care coordination services to help You manage Your healthcare. Always seek the advice of Your physician or other qualified health provider with any questions You may have regarding a medical condition.

We do not recommend or endorse any specific tests, health care providers, products, procedures, opinions, or other information that may be mentioned on the Site or by any other electronic means. The information provided through this Site is designed to support, not replace, the relationship that exists between a patient and a patient’s health care provider. Reliance on any general education information provided by Gaya Wellness through the Site is solely at Your own risk. Never disregard professional medical advice or delay in seeking it because of something You have read or seen on the Site. If You have any questions about Your medicines or treatment, Your care, or Your health conditions, consult Your doctor.

We collect, process, and use information about You as described in Our Privacy Policy, which is available here: This includes the use of cookies. By using the Site, You agree to the processing and the necessary cookies.

Communications

You understand that email communication can be intercepted by, or transmitted to, unintended third parties. You expressly agree to hold Gaya Wellness harmless for any damages associated with any breach of Your email or erroneous transmission. Disclaimer; No Warranty; No Liability

The content provided by and made available on the Site is for general information purposes only and is in no way intended to be a substitute for medical consultation with a qualified professional. We strongly encourage internet users to be careful when using medical information from the Site. If You are unsure about Your medical condition, consult a physician. Although We carefully review Our content, Gaya Wellness cannot guarantee or take responsibility for the medical accuracy of the content We provide, nor can We accept any liability for the content of information that is available through the Site.

While We attempt to keep the Site updated, neither We nor any employee or contractor warrants the accuracy, reliability, or timeliness of any information published on the Site or any website that links to or is linked from Our Site. Neither Gaya Wellness, any subsidiary or affiliate, nor any employee, owner, director, trustee, employee, or contractor shall be held liable for any losses caused by reliance on the accuracy, reliability or timeliness of such information. Any person or entity that relies on any information obtained using this Site does so at his or her own risk. While We exert reasonable efforts to maintain the privacy and security of all information that is accessible, or accessed, through the Site, all Users acknowledge that electronic information is susceptible to unauthorized access, and that such information may be used, disclosed, modified or corrupted without authorization or unintentionally.

All information contained on, or accessible through, this website is provided to You on an “as is” basis. Gaya Wellness does not warrant that it is accurate, complete, current, or reliable. To the fullest extent permitted by law, Gaya Wellness disclaims all warranties, either express or implied, statutory or otherwise. We disclaim all liability related to Your use of the Site, or Your inability to use the Site.

Gaya Wellness HEREBY DISCLAIMS, ON BEHALF OF ITSELF AND ITS SUBSIDIARIES AND AFFILIATES AND THEIR RESPECTIVE EMPLOYEES, OFFICERS, TRUSTEES, OWNERS AND CONTRACTORS (“Gaya Wellness INDEMNITEES”), ANY WARRANTIES, WHETHER EXPRESS, IMPLIED OR STATUTORY, INCLUDING WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT. THE Gaya Wellness INDEMNITEES WILL NOT BE LIABLE FOR ANY CLAIMS, CHARGES, DEMANDS, DAMAGES, LIABILITIES, LOSSES OR EXPENSES OF WHATEVER NATURE AND HOWSOEVER ARISING FROM THE SITE OR THIS PRIVACY POLICY INCLUDING BUT NOT LIMITED TO COMPENSATORY, DIRECT, INDIRECT, INCIDENTAL, SPECIAL, PUNITIVE OR CONSEQUENTIAL DAMAGES, HOWSOEVER ARISING INCLUDING THROUGH NEGLIGENCE, LOSS OF USE, LOSS OF DATA OR OTHER INFORMATION, LOSS OF INCOME OR PROFIT, LOSS OR DAMAGE TO PROPERTY, CLAIMS OF THIRD PARTIES OR OTHER LOSSES OF ANY KIND OR CHARACTER, EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES OR LOSSES, ARISING OUT OF OR IN CONNECTION WITH THE USE OF, OR THE INABILITY TO USE, THE SITE OR THE BREACH OF CONFIDENTIALITY OF DATA. TO THE EXTENT LIABILITY CANNOT BE EXCLUDED OR DISCLAIMED, OUR LIABILITY IS LIMITED TO PROVEN DIRECT DAMAGES NOT TO EXCEED FIVE US DOLLARS ($5 USD).

Each User shall be responsible for any loss, damage, claim, charge, demand, liability, loss or expense arising from or related to the use or failure to use the Site by such User, including costs related to introduction of viruses or other malware or a breach of privacy or security of the Site.

Your Promises

You promise that:
You are at least 18 years old, or if You are less than 18 years old,
Your parent or guardian has provided consent for You to use the Site.
You are able to agree to contracts and be legally bound by them. If You are not able to agree to and be legally bound by contracts, a parent or guardian that is able to be bound by contracts is agreeing to these Terms on Your behalf. The person that is able to be bound is responsible for ensuring Your compliance with these Terms.
You live in the United States.
You will be responsible for Your use of the Site. If You have a guardian or are under 18 years old, Your parent or guardian is also responsible for Your use of the Site.
You understand and agree that Gaya Wellness is not responsible to You, Your parents or Your guardian(s), and will not be liable to You, Your parents or Your guardians, for Your use or misuse of the Site, and You (or Your parents or guardians, as the case may be) will protect Gaya Wellness and will be responsible for any claims against Gaya Wellness and its employees and agents, by anyone related to Your use, misuse, or failure to use the Site.
You understand and agree that any links on the Site to other websites or to products, services, or merchandise not controlled by Gaya Wellness are offered by third parties, and that Gaya Wellness does not control, endorse, or guarantee such information, products, services or merchandise. You are responsible for reviewing the terms and privacy policy for any websites and other applications and deciding whether to agree to them, and We encourage You to do so.

You agree that the Site, or any component of the Site will NOT be used:

In an illegal, inflammatory, defamatory, obscene, or hateful manner;
To promote violence, discrimination on the basis of race, religion, gender, nationality, disability, age, or similar characteristics; or to infringe or breach the rights of any third party;
To threaten, abuse, harass, embarrass, alarm, defraud, or annoy another person;
To transmit any computer code, including (without limitation) any virus, worm, Trojan, time-bomb, logger, spyware, ransomware, or other harmful program or code that is intended, designed, or anticipated to cause harm or disruption to computers or networks, or any unsolicited promotional or advertising materials or “spam”; or
In a manner otherwise contrary to the nature and purpose of the Site to support health and health behaviors.

Intellectual Property Rights, Content

You may be able to upload certain information or content onto the Site. By uploading information onto the Site, You certify that You have the right to upload the information. Information uploaded onto the Site is not confidential, and You grant to Us an unlimited, perpetual, royalty free, fully paid-up, worldwide license to use that information for any purpose, in any format or media. We have the right to disclose Your identity and location to any third party who claims that any material uploaded or posted by You infringes any intellectual property right, or breaches any confidentiality or privacy right, or to other third parties as otherwise permitted or required by law. We are not responsible or liable for the content or accuracy of any content posted by You or any other user of the Site. We have the right to remove any content or information posted on the Site at any time.

Any content or information posted on the Site by a user must:

Not be illegal, inflammatory, defamatory, obscene, or hateful
Not promote violence
Not be sexually explicit
Not promote discrimination based on race, religion, gender, nationality, disability, age, or similar characteristics
Not infringe or breach the rights of any third party
Not threaten, abuse, harass, embarrass, alarm, or seek to annoy another person
Not seek to incite another to engage in any of the prohibited behaviors
Not seek to sell goods or services of a third party
Not misrepresent the source of the information
Be truthful, fair and appropriate given the nature and purpose of the Site to educate and support the attainment of health and healthy behaviors

Digital Millennium Copyright Notice

Gaya Wellness respects the rights of all copyright holders. If You believe Your copyright has been infringed, You may notify Gaya Wellness in emailing us at: info@gayawellness.org

To be effective, Your notice must include substantially the following, as provided for under the Online Copyright Infringement Liability Limitation Act of the Digital Millennium Copyright Act, 17 U.S.C. 512(c)(3):

Identification of the copyright work claimed to have been infringed, or, if multiple copyrighted works at a single online site are covered by a single notification, a representative list of such works at that site
A physical or electronic signature of a person authorized to act on behalf of the owner of an exclusive right that is allegedly infringed;
Identification of the material that is claimed to be infringing or to be the subject of infringing activity and that is to be removed or access to which is to be disabled, and information reasonably sufficient to permit Us to locate the material;
Information reasonably sufficient to permit Us to contact the complaining party, such as an address, telephone number, and, if available, an electronic mail address at which the complaining party may be contacted;
A statement that the complaining party has a good faith belief that use of the material in the manner complained of is not authorized by the copyright owner, its agent, or the law; and
A statement that the information in the notification is accurate, and under penalty of perjury, that the complaining party is authorized to act on behalf of the owner of an exclusive right that is allegedly infringed.

Gaya Wellness has adopted and reasonably implemented a policy that provides for the termination, in appropriate circumstances, of subscribers and account holders that are repeat infringers.

Permitted Uses of the Site

The Site may be used only for lawful purposes. The Site may not be used:

To violate the law
To harm or defraud anyone
To send or transmit materials that could not be uploaded as content
To transmit unsolicited promotional or advertising materials or spam
To transmit any computer code, including (without limitation) any virus, worm, Trojan, time-bomb, logger, spyware, ransomware, or other harmful program or code that is intended, designed, or anticipated to cause harm or disruption to computers or networks
To participate in a denial of service or other activity that is intended or likely to disrupt the efficient operation of the Site or any other website or computer network

Linking and Framing

You may place a link from the Site’s home page on another website, in a fair and legal manner, so long as the link does not adversely affect the reputation of Gaya Wellness or the Site. The link may not suggest any endorsement or approval of the other website by Gaya Wellness. You may not link to another page on the Site. You may not frame the Site on any other website.

Links to Other Websites

There may be links to other websites on the Site. The presence of a link to another website does not indicate any endorsement or approval of goods or services offered by the company or through the linked website. Each website has its own terms of use and privacy policy, which You should review before using the website. We are not responsible for the operation, terms or privacy policy of linked websites.

Enforcement of Terms

If any of the provisions of these Terms are held to be unenforceable, the remaining provisions will be unimpaired, and the unenforceable provision will be automatically replaced by an enforceable term or provision that comes as close as possible to the intention underlying the unenforceable term or provision. These Terms are subject to and do not alter any other agreements You have entered into with Gaya Wellness. We have the right to determine whether there has been a violation of these Terms. If We determine the Terms have been violated, We have the right to determine the action that will be taken. The action to be taken may include (but not be limited to):

Immediate termination of Your right to use the Site. The termination may be temporary or permanent.
Immediate removal of any content posted by You to the Site.
Issuance of a warning or other communication to You.
Legal proceedings against You, including seeking of damages (including indemnity) recovering all costs and losses suffered as a result of Your violation of the Terms.
Other forms of legal proceedings against You.
Referral to law enforcement agencies for further action.

We will not be liable for any damages which You may suffer as a result of the foregoing actions.

Jurisdiction and Applicable Law

The law of the State of New York will apply to all proceedings related to the Site and these Terms. The Site, excluding unaffiliated linked sites, is controlled by Gaya Wellness, which is located in New York, United States. If You are using the Site when outside the United States of America, Your information will be transferred to, stored, and processed in the United States. The privacy laws of the United States may not be as protective as those in other jurisdictions. By using the Site, You acknowledge that We collect and process Your data as described in these Terms. We collect and use information as reasonably necessary to fulfill Your requests for Our services, to operate Our business, and to comply with law. You acknowledge that these are acceptable reasons to collect and process Your data. You also consent to the transfer of Your information to the United States and the use and disclosure of Your information as described in this Privacy Policy. If You are located outside the United States of America, You acknowledge and agree that Your data will be stored and processed in the United States, which may have privacy laws that are less protective than the laws of the country in which You are located. By using the Site, You consent to the processing of Your data in the United States for the purposes described in these Terms, the Privacy Policy, and any documentation regarding the Site, and as permitted by law.

Changes to the Terms of Use

We have the right to change, amend and modify the Terms at any time. We will post the revised Terms on the Site, with a changed “Last Revised” date. You are expected to check this page from time to time for changes to the Terms, as they are binding on You. If You have questions, We can be contacted at: info@gayawellness.org or by post to:

Gaya Wellness, PLLC
PO Box 77816
Winter Garden, FL 34777
United States

Telehealth Consent Form

Telehealth/Telemedicine is the delivery of healthcare services when the healthcare provider and the patient (the “Patient”) are not in the same physical location and communicate through technology. You can talk to Dr. Patel by phone, computer or tablet. But, in order for your telemedicine consult to be reimbursable by your insurance or third-party payors, we will need to use a video device or feed and have a video connection in which Dr. Patel can observe you as the Patient. Electronically transmitted information may be used for diagnosis, treatment, follow-up, prescription, or education and may include medical records, medical images, interactive audio, video and/or data communications, and output data from medical devices, sound and video files. By executing this Consent Form, the Patient is acknowledging and agreeing that the Patient understands and consents to the following with respect to telemedicine offered by Shweta Patel, M.D., and GAYA WELLNESS, PLLC (collectively the “Service Provider”):

The Patient has elected to have a telemedicine visit instead of an in-office visit. The Patient agrees that the Service Provider will determine whether the Patient’s condition is appropriate for telemedicine and acknowledges that the Service Provider may recommend an in-person visit. The Patient and the Service Provider will not be in the same room or physical location during the telemedicine visit, so the visit may feel different than an office visit. Because the Patient and the Service Provider are not in the same physical location or room during the telemedicine visit, there are some potential risks associated with the use of telemedicine and telehealth.
The potential risks associated with the use of telemedicine include, but are not limited to: the information transmitted may be less comprehensive than that available from an in-person visit and result in decreased accuracy of diagnosis or medical decision-making; delays in medical evaluation or treatment could occur due to deficiencies or failures of the telemedicine equipment; and security protocols could fail, causing a breach of privacy. The Patient understands that telemedicine often involves electronic transmission of the Patient’s protected health information (“PHI”). The Patient’s PHI includes, but is not limited to, the Patient’s identifying information; medical history; diagnoses; communications to and from the Patient’s other health care provider(s); etc. The Patient understands that PHI may be lost due to technical failures, cyber intrusion or other issues disrupting the Patient’s telemedicine visit or causing delays in response from the Service Provider. The Patient assumes these risks, and to the extent permissible under applicable federal and Florida law, agrees to hold the Service Provider and it’s representatives harmless from any claims arising out of the use of telemedicine to conduct the visit.
The Patient understands that telemedicine visits may be recorded and that the laws that protect privacy and confidentiality of medical information also apply to telemedicine. If the Service Provider deems it necessary to record any of the Patient’s telemedicine visits, the Service Provider will first notify the Patient that it is necessary to record the telemedicine visit and obtain the Patient’s verbal consent to such recording once the video portion of the telehealth visit is commenced. The Patient has the right to refuse the recording of the telemedicine visit and if the Patient refuses such recording, the Service Provider does have the right to decline the telemedicine visit at that time.
The Patient understands that PHI obtained during the telemedicine visit will not be disclosed to other entities without the Patient’s consent unless otherwise permitted by applicable law or in accordance with the Service Providers Notice of Privacy Practices. The Patient has the right to withhold or withdraw consent for telemedicine at any time without affecting the right to the Patient’s future care, treatment, benefits, or programs for which he or she is otherwise entitled. Any such withhold or withdrawal of consent shall be given in writing, and shall be deemed to be properly delivered upon receipt if sent by: (a) certified U.S. mail, return receipt requested, (b) facsimile, or (c) personal delivery with receipt, to the principal address of the Service Provider.
The Patient understands that if others are present at Patient’s location during the Patient’s telemedicine visit, the confidentiality of the Patient’s telemedicine visit may be compromised. The Patient acknowledges and agrees that the Patient has the choice of and control over allowing others to be present at the Patient’s location during the Patient’s telemedicine visit. Therefore, by allowing others to be present at the Patient’s location during the Patient’s telemedicine visit, the Patient is consenting to the disclosure of the Patient’s PHI and other information discussed and/or disclosed during the visit. By executing this Consent Form, the Patient acknowledges and agrees that it is the Patient’s responsibility to disclose to the Service Provider whether others are present at the Patient’s location during the telemedicine visit, as well as that it is the Patient’s responsibility to determine if they want others present during the telemedicine visit, and if not to ensure that any other person present at the Patient’s location is not in the room during the telemedicine visit and cannot hear or have access to the discussion between the Patient and Service Provider
The Patient understands the alternatives to telemedicine as they have been explained, and in choosing to participate in a telemedicine visit understands that some parts of the exam may require physical testing to be performed at another location at the direction of the Service Provider.
THE PATIENT UNDERSTANDS IT IS POSSIBLE THAT HEALTH INSURANCE WILL NOT COVER THE TELEMEDICINE VISIT(S). THE PATIENT MAY ELECT TO PAY OUT OF POCKET FOR THE TELEMEDICINE SERVICES IF THEY ARE NOT COVERED BY HEALTH INSURANCE. THE PATIENT AGREES THAT IF THE HEALTH INSURER DOES NOT PAY FOR THE TELEMEDICINE SERVICES, THE PATIENT WILL BE RESPONSIBLE FOR PAYMENT. THE PATIENT FURTHER UNDERSTANDS THAT HE OR SHE IS RESPONSIBLE FOR ALL COST SHARING OBLIGATIONS (E.G., COPAYMENT, COINSURANCE AND/OR DEDUCTIBLE) REQUIRED BY THE HEALTH INSURANCE PLAN (“COST SHARING OBLIGATIONS”). ALL OUT-OF-POCKET EXPENSES ASSOCIATED WITH THE TELEMEDICINE VISIT, INCLUDING COST SHARING OBLIGATIONS AND PAYMENT FOR NON-COVERED SERVICES, ARE DUE PRIOR TO THE TELEMEDICINE VISIT IF SUCH AMOUNTS ARE KNOWN AT THAT TIME.

8. The Patient understands that a patient must be physically located in the State of Florida during his or her telemedicine consultation(s) and represents that the Patient is located in the State of Florida during the entirety of each telemedicine visit. The Patient understands that if he or she is not physically located in the State of Florida, the Practice may decline to treat him or her via telemedicine. The Patient understands that the Patient must be a NEW patient and have not ever received any medical services by or were under the care of , directly or indirectly, the Service Provider or its Representatives prior to the signing of this Consent Form. The Patient understands that if they have already received medical services by or were under the care of, directly or indirectly, Dr. Shweta Patel or at or through Physician Associates, LLC or Orlando Health Medical Group, Inc., during the period from 4/15/2019-3/2/2022, the Patient must be physically located outside a 10-mile radius of the following address: 17000 Porter Road, Winter Garden FL 34787, during his, her, or their telemedicine consultation(s) . The Patient further attests that by signing this Consent Form, the Patient is either a NEW patient or is physically located outside of a 10-mile radius of the following address: 17000 Porter Road, Winter Garden FL 34787 during the entirety of each telemedicine visit. The Patient understands that if he or she or they are physically located in the within the 10-mile radius of 17000 Porter Rd, Winter Garden FL 34787, and have received medical services by or were under the care of, directly or indirectly, Dr. Shweta Patel or at or through Physician Associates, LLC or Orlando Health Medical Group, Inc., during the period from 4/15/2019-3/2/2022, the Service Provider and its representatives may decline to treat him or her or them via telemedicine consultation(s).
9. The Patient understands that the Service Provider and its representatives are located in the State of Florida and are licensed to provide telemedicine services only within the State of Florida. The laws of the State of Florida will govern any potential disputes, and the Patient consents to jurisdiction in the State of Florida for any such disputes.
10. The Patient has been advised of all the potential risks, consequences and benefits of telemedicine. The Service Provider has discussed with him or her or them, information provided above and the Patient has had the opportunity to ask questions about the information presented on this form. All the Patient’s questions have been answered, and he or she or they understand(s) the information.

Medically Guided Weight Loss Program Patient Informed Consent

Request for Treatment:

I voluntarily request that Gaya Wellness PLLC treat my medical condition.
I have informed my provider of any known allergies, my medical conditions, medications, social/family history.I understand the mechanism of action of the medication.I understand how it is to be administered.It has been explained to me that this medication could be harmful if taken inappropriately or without advice from the provider.I understand this medication may cause adverse side effects (see below). I understand this list is not comprehensive. I understand symptoms may be worse after there has been a change in my medication dose or when first starting the medication.

Common side effects of weight loss medication such as GLP-1 Agonists include, but are not limited to:

Gastrointestinal: Nausea/vomiting, abdominal pain, Diarrhea/constipation, dyspepsia, abdominal distension, eructation, flatulence, gastroenteritis, GERD, gastritis, lipase increase, amylase increase
Neurological: Headache, dizziness
Cardiac: Heart rate increase, Hypotension
Endocrine: Fatigue, hypoglycemia (diabetic patients), alopecia
Ophthalmic: Retinal disorder (diabetic patients)
Skin: redness or pain at injection site

Serious Reactions include, but are not limited to:

Thyroid C-cell tumor (animal studies)
Medullary thyroid cancer
Hypersensitivity reaction
Anaphylaxis
Angioedema
Acute kidney injury
Chronic renal failure exacerbation
Pancreatitis
Cholelithiasis
Cholecystitis
Syncope

Terms of Membership Agreement:

Price: I understand the membership is priced at $99/month with a 3 month minimum duration and a 30 day advance notice for cancellation required.

Benefits: I understand that I will have 2 (15 minute duration) virtual visits included per month in this plan as well as access to unlimited concierge text and email support.

Insurance Approval for Prescriptions: I understand that the team at Gaya Wellness will do their best to help me with insurance coverage for the weight loss medications that will be prescribed to me in this program. I understand that it is possible that despite the best efforts of the Gaya Wellness Team, I may still not be approved for insurance coverage and have to pay cash for these medications in order to continue with the program.
Safety: I will take my medications only as prescribed according to the directions, led by Gaya Wellness PLLC. If I feel my medications are not effective, or are causing undesirable side effects, I will contact my provider for instructions. I will not adjust my medications without prior instruction to do so. I understand this medication must be self-injected in the subcutaneous tissue once weekly. The medication expires after 12 weeks. I will refer to the Beyond Usage Date (BUD). I understand it is important to keep my medication away from children (<18 years old). I am the only one who will use my medication. I will not give or sell my medication to anyone else. If the provider deems it appropriate to start weaning my medication or transition to maintenance dosing, I will comply.

Discontinuation of medication: I understand that provider may stop prescribing my medications if:

I am having unfavorable side effects or it’s not working
I have been untruthful in my medical or family history
I do not follow through with the recommended plan of care set by provider
I do not follow any parts of “ 4. Responsibilities” in this agreement.

Responsibilities:

I will provide accurate weight, body fat composition and body measurements at the beginning as well as routinely every 2 weeks for my provider to successfully track my progress and make adjustments as needed.
I will provide photo documentation using 3 poses ( Front, Side, Back), ideally in the same location, lighting and clothing, initially at the start of my weight loss journey as well as periodically throughout the program and end of the program. I give my provider permission to use these images only for the purposes of tracking my progress. I understand that these images may only be used for marketing purposes if I provide specific consent to do so at that time.
I will be present for my scheduled virtual calls on time, in a location that is a favorable environment for having a productive and clear conversation. This includes having adequate sound, light and internet control to facilitate the quality of the virtual call.
I will comply with the recommendations of my provider with regards to modifications in my diet, exercise and behavioral tendencies- as needed to attain the maximum success in this program.
I will participate in the behavioral modification component of this program with the exercises that are assigned to me such as journaling and coaching sessions during my calls.

Money Back Guarantee:

I understand that I may qualify for a refund of the Membership Fees (minus a $150 fee for your initial doctor appointment) if I do not achieve a minimum of 10% weight loss at the end of my Gaya Wellness Weight Loss Program. My weight loss will be determined by calculating the percentage change of my weight from the start to the end of my program. For purposes of calculating weight loss percentage, Gaya Wellness PLLC will use my first reported weight from my intake questionnaire.

I Must Meet the Following Criterion:

Not have been taking any prescription weight loss medication during the twelve months prior to purchasing your Program (examples include: phentermine, GLP-1 medications like Ozempic, Saxenda, or Wegovy);
Self-paid (not through an employer or insurance program);
Completed the entire one-year in the Program
Complied with 2 virtual check ins per month for tracking of progress
Not canceling or missing more than 4 consecutive, or 7 total, virtual sessions.

I understand that if I am eligible for money back based on the criteria set forth above, I will receive a refund as described in our Refund Policy.

I have read this form in its entirety. It has been explained to me. I have had the opportunity to ask questions and have all my questions answered. I fully understand the above information and have no further questions. By signing this form, I voluntarily give my consent for treatment and agree to the risks.

Gaya Wellness Spam Policy

SPAM POLICY

Welcome to Gaya Wellness. We value your privacy and are committed to providing a spam-free experience for our users. This Spam Policy outlines our guidelines for sending emails and text messages to ensure that our communication is respectful, relevant, and compliant with applicable laws and regulations.

1. Consent-Based Communication
We only send emails and text messages to individuals who have provided their explicit consent to receive communications from Gaya Wellness. Consent can be obtained through opt-in forms on our website, mobile app, or other communication channels. We respect your decision to unsubscribe at any time, and every message we send includes an option to opt-out.

2. Compliance with Anti-Spam Laws
We comply with all applicable laws and regulations related to email and text messaging, including the CAN-SPAM Act, GDPR, and CASL. Our communications include accurate sender information, subject lines, and opt-out mechanisms, as required by these laws.

3. Clear and Honest Communication
Our messages are clear and honest, providing accurate information about our products, services, and promotions. We do not use deceptive tactics, false claims, or misleading subject lines to attract attention.

4. Frequency and Relevance
We strive to send emails and text messages that are relevant and valuable to our recipients. We monitor the frequency of our communications to avoid excessive messaging and ensure that our content remains meaningful.

5. Data Protection
We take data protection seriously. Your personal information is stored and processed in accordance with our Privacy Policy, which outlines how we collect, use, and protect your data.

6. Third-Party Partners
In some cases, we may work with third-party partners to send emails or text messages on our behalf. These partners are required to adhere to the same spam policy and data protection standards as outlined here.

7. Reporting Spam
If you believe you have received a spam email or text message from Gaya Wellness, please report it to our customer support team immediately. We will investigate and take appropriate action to prevent future occurrences.

8. Contact Information
If you have any questions or concerns regarding our Spam Policy or how we handle your data, please contact us at:
Gaya Wellness
PO BOX 770816, Winter Garden FL 34777
Info@gayawellness.org

9. Policy Updates
We may update this Spam Policy from time to time to reflect changes in our practices or legal requirements. Updates will be posted on our website, and the effective date will be modified accordingly.
By interacting with Gaya Wellness through email or text messaging, you agree to abide by this Spam Policy. We appreciate your trust and strive to provide you with a positive communication experience.

Privacy Policy

Privacy Policy

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Gaya Wellness PLLC is committed to protecting the privacy and security of our customers’ data. To that end, we operate in compliance with all applicable privacy and data protection laws including the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended by the Health Information Technology for Economic and Clinical Health Act of 2009 (“HITECH”) and implementing regulations.

This Notice of Privacy Practices describes the practices that we will follow with respect to the privacy of the health information of users of this site and our mobile applications and related services (“Services”).

What Health Information We Collect
In providing our Services, some of the information we collect may constitute protected health information (“PHI”) under HIPAA. PHI is personal (individually identifiable) information about you that relates to (a) your past, present or future physical or mental health or condition, (b) the provision of health care to you, or (c) your past, present, or future payment for the provision of health care, which is created, received, transmitted or maintained by Gaya Wellness. This Notice of Privacy Practices describes how we protect the privacy of your protected health information as a user of our Services. As a provider of health services, Gaya Wellness has certain obligations under HIPAA for maintaining the privacy and security of your PHI collected while performing our Services.

What Information We Disclose
When you use our Services, Gaya Wellness may use and disclose your PHI for the purposes described below. These uses and disclosures do not require your prior authorization. You may revoke your authorization for us to use or share your health information at any time, except for uses or disclosures we have already made. Gaya Wellness may use and disclose your health information for the following purposes:

Treatment:
We can use and share your health information with healthcare professionals to treat you. For example, we can disclose your information to another healthcare provider to personalize your experience.

Payment:
We may use and share your health information to obtain payment for our services. For example, we may disclose your PHI to your health plan to determine whether you are enrolled with the payer or eligible for health benefits or to get payment for our services.

Health Care Operations:
We may use and share your health information for our operations related to health care.

Business Associates:
From time to time, we work with other companies and individuals who help us deliver our services, known as “business associates.” These entities are required to keep any PHI confidential and store it securely.

De-identifiable and Aggregated Data:
We may use and disclose your PHI in a de-identifiable and aggregated manner to analyze our users’ experiences and help improve our services.

Research:
We can use or share your information for health research as authorized by law.
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As Required by Law:
We may use or disclose your PHI if state or federal laws require it.

Public Health and Safety:
We may use and disclose your PHI to prevent or minimize a serious threat to your health and safety or that of another person. We may also disclose PHI to those assisting in disaster relief efforts so that others can be notified about your condition, status and location.

Law Enforcement Activities:
We may also provide PHI to law enforcement officials, for example, in response to a warrant, investigative demand or similar legal process, or for officials to identify or locate a suspect, fugitive, material witness, or missing person. We may also disclose PHI to appropriate agencies if we reasonably believe an individual to be a victim of abuse, neglect or domestic violence.

Legal Proceedings:
We may disclose PHI to respond to a court or administrative order, or in response to a warrant, investigation demand or other legal process.
We may also use and disclose your PHI for other purposes as permitted by HIPAA.

Note Regarding State Law
Where state law is more restrictive of disclosure than federal law, we are required to follow the more restrictive state law.

Your Rights
As a user of Gaya Wellness services, you have rights with respect to your health information:

• Right to Inspect and Obtain a copy of PHI: You have a right to inspect and obtain a copy of your protected health information we maintain.
• Right to Request Restrictions: You may request that we limit what information we use or share. We will notify you within 60 days whether we can agree to your request. If you pay for a service or health care item out of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share.
• Right to Request Alternative Means of Confidential Communication: You have the right to request that copies of your medical information be provided by alternative means.
• Right to Request Corrections: You have a right to request that we correct your protected health information that you think is incorrect or incomplete.
• Right to Receive an Accounting of Disclosures: You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
• Right to Obtain a Paper Copy of this Notice: You have the right to obtain a paper copy of this notice upon request at the address below.
• Right to File a Complaint: You may file a complaint with us if you believe your Privacy Rights have been violated. To file a complaint, or to ask any questions about this Notice of Privacy Practices, send an email to us at info@gayawellness.org, or write to us at the following address: POBox 77816 Winter Garden Fl 34777.
• You also have the right to file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against any individual for filing a complaint. Our Responsibilities• We are required by law to maintain the privacy and security of your protected health information.
• We will not use or disclose your PHI for marketing purposes or to sell your PHI, unless you have agreed to this use or disclosure.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

Changes to the Terms of this Notice
From time to time, we may change this privacy statement, which is applicable to all PHI we maintain about you. For example, as we update and improve our services, new features may require modifications to the privacy statement. The new notice will be available on our website. Accordingly, please check back periodically.

Cancellation Policy

Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the therapists’ day that could have been filled by another patient. As such, we require 24 hours notice for any cancellations or changes to your appointment. Patients who provide less than 24 hours notice, or miss their appointment, will be charged a cancellation fee to the card on file.