HIPAA Notice of Privacy Practices

Medical care offered through Forma Wellness is delivered by independent licensed providers and their affiliated medical groups (the "Providers"), who are the covered entities responsible for your medical records. DynaWell Peptides Inc, 2560 King Arthur Blvd, Suite 124 #39, Lewisville, Texas 75056, operates the platform and processes limited information on the Providers' behalf under written safeguards consistent with HIPAA's requirements for business associates.

• Treatment — Providers use your intake answers, identity documents, and messages to evaluate, treat, and follow up on your care, and share them with pharmacies to fill your prescriptions.
• Payment — information may be used to process payment for services and medications you request.
• Healthcare operations — quality review, safety monitoring, credentialing, and compliance activities.
• As required by law — public-health reporting, abuse or neglect reporting, health oversight, judicial proceedings, and law enforcement where legally mandated.
• To avert a serious threat — where necessary to prevent a serious and imminent threat to health or safety.

Uses and disclosures other than those described above — including most uses for marketing, any sale of PHI, and most sharing of psychotherapy notes — require your prior written authorization, which you may revoke at any time.

• Right to access — obtain an electronic or paper copy of your medical record, usually within 30 days of request.
• Right to amend — ask that inaccurate or incomplete information be corrected.
• Right to an accounting of disclosures — receive a list of certain disclosures made of your PHI.
• Right to request restrictions — ask for limits on how your PHI is used or shared (Providers are not required to agree to all restrictions, except where the law requires).
• Right to confidential communications — ask to be contacted in a specific way or at a specific location.
• Right to a paper copy of this notice, and to be notified in the event of a breach of unsecured PHI.

To exercise any of these rights, contact your care team through the patient portal or email telemed@formawellness.com — requests are routed to the responsible Provider.

• Health information you submit is transmitted encrypted (TLS) directly to clinical systems; the commerce platform retains only non-medical routing records (case identifiers, statuses, timestamps).
• Patient-portal access requires a one-time code sent to your email; messages with your care team are relayed from clinical systems and are not stored in the commerce database.
• Email notifications never contain medical content.
• Access to systems that process PHI is restricted, logged, and reviewed.

If you believe your privacy rights have been violated, you may file a complaint with us at telemed@formawellness.com or by mail at the address below, and with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201, or via www.hhs.gov/ocr/privacy/hipaa/complaints. You will not be retaliated against for filing a complaint.

The terms of this notice may be changed at any time, with the new terms applying to all PHI maintained. The current version will always be available on this page with its effective date.

For questions about this document, your account, billing, or your data, contact us at telemed@formawellness.com, or by mail:

DynaWell Peptides Inc
2560 King Arthur Blvd, Suite 124 #39
Lewisville, Texas 75056