IGNITE
Client Agreements & Consents
One form, one signature. Takes about eight minutes. Your information is protected — see the privacy section below.
IGNITE
Initial each block to confirm you've read it. These apply to everyone at Ignite regardless of which services you use.
Ignite is a cash-pay practice. We do not bill Medicare, Medicare Advantage, Medicare Part D, Medicaid, TRICARE, VA, or commercial insurance for any service.
For compliance purposes we treat any client age 65 or older as Medicare-eligible regardless of actual enrollment. If you are 65 or older, some medical services may be unavailable to you here, and hormone optimization is not available at all — we'll refer you to a Medicare-participating provider.
I agree not to submit claims to Medicare or any government health program for Ignite services or products.
Any receipt we give you is for your records. It is not a guarantee of reimbursement, coverage, or HSA/FSA eligibility — those decisions belong to your plan administrator and tax advisor, not to us.
Pricing is provided in a separate written estimate. Payment is due as agreed at the time of service or on your billing date.
Medications and products are dispensed for your personal use only and are non-refundable once dispensed. Initiating a chargeback on services rendered or products dispensed does not void the amount owed.
We ask for reasonable notice on cancellations and reschedules.
I consent to Ignite contacting me about scheduling, appointment reminders, service updates, follow-up instructions, billing, lab results, and educational content related to services I've requested or received.
Check every channel you're comfortable with:
Secure messaging is available any time you want it — just ask, and we'll use it. Consenting to email and text simply lets us do the practical things, like sending your lab results straight to you when they come in instead of making you log into a portal to read them.
Email and text are not fully secure channels. By selecting them above I authorize Ignite to send me health-related information, including lab results, through them, and I accept the privacy risks that come with that. I can withdraw this at any time and ask for secure messaging instead.
We use administrative, technical and physical safeguards to protect your health-related information — secure systems, access controls, limited internal access, and reasonable vendor safeguards.
We may use or disclose your information to deliver services you've requested, process payment, coordinate your care with your authorization, meet legal obligations, or respond to an emergency. We do not sell client health information.
You may request access to your records, ask for corrections, request restrictions, or ask us to communicate with you differently. Write to info@ignitepah.com.
Exercise carries real risk. That includes muscle strain, sprain, joint injury, dislocation, fracture, soft-tissue injury, cardiac or respiratory events, fainting, dehydration, heat illness, allergic reaction, and in rare cases serious injury or death.
I'm participating voluntarily. I'm in sufficient health to take part, I've answered the health screen honestly, and I'll tell you promptly about any new condition, injury, medication or symptom.
To the maximum extent Missouri law allows, I release Ignite Performance & Health and its owners, employees, contractors, agents and trainers from claims arising out of my participation — except for gross negligence or willful misconduct. Nothing here waives a claim that can't be waived under Missouri law.
Trainers are not medical providers. Any medical concern needs evaluation by a physician. In an emergency, staff may call 911.
This release relies on the accuracy of what you've told us. Withholding something material may void it as to a claim arising from what wasn't disclosed.
Ignite nutrition coaching is general wellness and body-recomposition coaching delivered alongside your training. It teaches practical skills: food selection, macronutrient awareness, meal timing, grocery and prep habits, and behavior change.
It is not:
Our nutrition coaches are not registered dietitians unless we've told you in writing for a specific coach.
If you have a medical condition where diet matters — diabetes, kidney disease, hypertension, cardiovascular or GI disease, a history of disordered eating, pregnancy or postpartum — talk to your physician before making nutrition changes, and disclose it on your medical history form.
I understand I am not engaging Ignite to provide medical nutrition therapy or to treat a disease.
Some products used at Ignite are compounded by a licensed pharmacy and are not FDA-approved finished drug products. Compounded products are not reviewed by the FDA for safety, effectiveness, or manufacturing quality in the way approved products are.
Some medications may be prescribed off-label — for a use, dose or route not in the FDA-approved labeling. Off-label prescribing is legal and common, and it means the evidence base varies by product.
I'll give honest, complete information about my medical history, medications, supplements, allergies and lifestyle. Withholding information affects how safe and effective these services are, and may be grounds for Ignite to decline or discontinue them.
I'll report side effects, new symptoms, new diagnoses, new medications, pregnancy, or a planned surgery promptly. I understand Ignite or my provider may pause or discontinue any therapy at any time for safety, compliance, or clinical judgment, and that I may stop at any time.
No specific physical, medical, aesthetic, performance or weight result is guaranteed. Individual results vary.
You can authorize us to exchange information with your other providers. This is optional and isn't a condition of receiving services. It expires 12 months from signing unless you revoke it sooner.
Everyone reads all three, whether or not you're starting that therapy today. That way you're covered if you add one later — no second round of paperwork.
Semaglutide and tirzepatide slow stomach emptying and reduce appetite. Common effects: nausea, vomiting, diarrhea, constipation, reflux, fatigue, and loss of muscle along with fat.
Serious risks include pancreatitis, gallbladder disease, kidney injury from dehydration, low blood sugar (especially with other diabetes medications), and a boxed warning for thyroid C-cell tumors seen in rodents.
Tell your provider before starting if you have a personal or family history of medullary thyroid carcinoma or MEN2, pancreatitis, gallbladder disease, gastroparesis or severe reflux, type 1 diabetes, an eating-disorder history, severe kidney or liver disease, or if you are pregnant, may become pregnant, or are breastfeeding.
Ignite provides this as elective, cash-pay weight management — not as treatment for diabetes or any Medicare-covered condition.
Covers testosterone, estrogen, progesterone, enclomiphene, anastrozole and hCG. Some are compounded.
Risks vary by hormone and include thickening of the blood requiring monitoring or donation, effects on fertility and sperm production, acne and hair changes, mood changes, worsening of sleep apnea, blood-clot risk, cardiovascular risk, and effects on hormone-sensitive tissue. Ongoing lab monitoring is part of therapy, not optional.
Tell your provider if you have a personal or first-degree family history of hormone-sensitive cancer, prior blood clot, stroke or TIA, active heart disease, polycythemia, untreated sleep apnea, liver disease, unexplained vaginal bleeding, migraine with aura, or if you are pregnant, may become pregnant, or are breastfeeding.
Lab monitoring is a condition of continued therapy. Your provider sets the schedule for lab draws and reviews them before authorizing continued treatment. If you do not complete your labs on the schedule your provider establishes, a timely refill is not guaranteed and therapy may be paused until current results have been reviewed. This is a safety requirement, not an administrative one — hormone therapy is titrated against your labs.
Not available to clients age 65 or older under our current compliance policy. If you turn 65 during therapy we'll transition you to a Medicare-participating provider.
Peptides are short amino-acid chains signalling pathways related to tissue repair, growth-hormone release, metabolism, sexual function, cognition and longevity. Most are not FDA-approved drug products and the evidence base is limited and varies considerably between them.
Category risks include injection-site reactions, allergic reaction, water retention, joint pain, changes in blood sugar or insulin sensitivity, blood-pressure or heart-rate changes, mood or sleep changes, flushing and nausea. What you're prescribed is individualized to you and discussed with your provider.
Tell your provider if you have active or recent cancer, diabetes, an active psychiatric condition or take serotonergic/MAOI/psychotropic medication, recent or planned surgery, are on anticoagulation, have severe cardiovascular, kidney or liver disease, G6PD deficiency, or if you are pregnant, may become pregnant, or are breastfeeding.
These apply to every prescribed therapy above.
Order refills at least one week before you need them. Compounded medications are prepared to order by a pharmacy — they are not pulled off a shelf. Requests made with less than a week's notice may not arrive before you run out, and we can't guarantee otherwise.
Your provider sets the lab schedule for your therapy and reviews results before authorizing continued treatment. Refills are contingent on your labs being current. If your labs are overdue, expect your refill to be delayed until they've been drawn and reviewed.
Plan ahead around travel, holidays and pharmacy closures. If you're going to be away, tell us before you leave rather than when you're already out.
Completely optional and never a condition of service. Saying no changes nothing about your care.
If you granted permission, check only what you're comfortable with:
How may we identify you?
We will never publish your diagnoses, lab values, prescription details, medication names or dosages.
By signing, I confirm I've read and understood each section above, that the information I've given is honest and complete, and that I'm signing this electronically with the same legal effect as a handwritten signature. Missouri law governs; venue is St. Louis County.
Your signature is recorded with a timestamp and IP address as part of the audit trail.
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