Medical Digital Consent — Dr. José Moya

👤 Patient Information

Full name *

ID document (national ID / passport) *

Date of birth *

Phone / WhatsApp *

Email address (optional)

Country of residence

⚖️ Informed Consent

I have been informed about the nature, scope and limitations of the medical services offered by Dr. José Moya through AAHHOO Corporation, and I freely give my informed consent for the following:

Services and procedures

Remote medical consultation (telemedicine) Clinical evaluation, diagnostic guidance and treatment recommendations through digital platforms (WhatsApp, Zoom, video). I understand that remote consultation does not replace in-person evaluation in emergency cases.

System 133 — Longevity & Biological Age Program Biological age assessment, personalized supplement protocol, monthly follow-up and lifestyle recommendations based on Dr. Moya's protocol. Includes WhatsApp consultations according to the contracted plan.

308nm Excimer Phototherapy — NMS-1M Device (Rental or Purchase) Supervised use of the phototherapy device for vitiligo and psoriasis treatment. I understand that: (a) I must perform the initial MED test, (b) I must send monthly photographs, (c) in rental mode the device remains property of Dr. Moya, and (d) there are UV exposure risks which I have been instructed to read about in the manual.

Helper Cream — Specialized Topical Cream Use of the topical product per Dr. Moya's instructions. I understand I must report adverse reactions and that the product is a cosmetic/dermatological complement, not a registered medication.

INTRURA — Personalized Genomic Analysis Medical interpretation of genomic data (23andMe or other provider). I understand that genetic data is sensitive in nature and will be treated with strict confidentiality, not shared with third parties without my express authorization.

📸 Clinical Photography Authorization

I authorize Dr. José Moya to request, receive, store and analyze clinical photographs of the treatment areas for the following exclusive purposes:

Visual monitoring of treatment progress
Protocol adjustment based on observed response
Medical documentation of the clinical case
Comparative assessment before/during/after treatment

⚠️ Photographs will NOT be published on social media, digital platforms or used for commercial or public educational purposes without an additional specific written authorization from the patient.

I expressly authorize the use of my clinical photographs for the follow-up and protocol purposes described above.

📌 General Declarations

I have fully read and understood this informed consent.

I authorize Dr. Moya to perform the evaluations and treatment recommendations he deems appropriate for my condition.

I understand that no treatment guarantees specific results and I commit to reporting any adverse reactions.

I agree to receive medical follow-up communications, reminders and educational health content through the agreed digital channels.

I confirm that all information provided in this form is truthful and complete.

I understand I may withdraw this consent at any time by notifying Dr. Moya in writing.

I authorize receiving educational health communications and appointment reminders.

🔒 Confidentiality & Data Protection

All medical information, personal data and photographs will be treated with strict confidentiality in accordance with applicable data protection laws. Information will not be shared with third parties without express consent, except as required by law or a medical emergency.

⚖️ Jurisdiction
This consent is governed by the laws of the State of Florida, United States. Dr. José Moya operates under AAHHOO Corporation, based in Miami, Florida, USA.

✍️ Patient Digital Signature

Sign in the box with your finger or stylus:

⚠️ Please provide your signature before submitting.

✅ Consent Registered!

📋 Medical Digital Consent