Informed Consent
Updated: June 2025
ROSERX INFORMED CONSENT
IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL YOUR HEALTHCARE PROVIDER OR 911 IMMEDIATELY. NEITHER ROSERX NOR ITS PARTNERS PROVIDES ANY SERVICES FOR MEDICAL EMERGENCIES.
PLEASE READ THIS CONSENT CAREFULLY BEFORE USING THE SERVICES.
BY CLICKING “I ACCEPT”, YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS CONSENT AND THAT YOU HAVE AGREED TO RECEIVE THE SERVICES DESCRIBED BELOW. IF YOU DO NOT ACCEPT, YOU WILL NOT BE ABLE TO USE OR RECEIVE THE SERVICES.
Proteomics International USA Inc (“Proteomics International”) provides a website (the “Site”) through which consumers can access information and resources regarding chronic kidney disease (CKD) risk and the PromarkerD test. The Site is operated by Rosemary Health Pty Ltd T/A RoseRx (“RoseRx”), who also operates and manages the underlying services platform (the “Portal”) used to request and purchase services related to the PromarkerD test. If eligible, consumers may access telehealth evaluations, clinical services, and laboratory testing (each, a “Test”), with sample collection conducted either at a laboratory patient service center (“PSC”) or via in-home phlebotomy (collectively, the “Services”).
RoseRx partners with independent third-party service providers (“Partners”), including laboratories, clinical service providers, and the developer of the PromarkerD test, to facilitate access to and delivery of these Services.
Your use of the Services is governed by this Consent as well as the Website Terms of Service, Program Terms of Service, Privacy Policy, Clinician Group (as defined below) policies and any additional consents you provide or terms which RoseRx or its Partners may provide to you.
You acknowledge and agree to the following:
- You are the individual or the authorized parent or guardian of the individual who will provide the sample for the Test(s) that you have requested. You understand that there are penalties for providing incorrect information regarding your identity.
- Any information you have provided is correct to the best of your knowledge. You will not hold RoseRx or any of its Partners responsible for any errors or omissions that you may have made in providing such information.
- You are at least eighteen (18) years of age.
- You reside in the United States and during the provision of the Services relating to the Tests you will be located in the United States, in the state of residence you provided during Test registration. Please notify contact@roserx.health if the state where you are located changes during the provision of the Services.
- You have read and understood the information about the Test(s) that you have been provided, including on the RoseRx consumer platform (the “Portal”). You understand that you may discuss the proposed testing with your healthcare provider and ask any questions regarding the Test(s).
- You must provide an appropriate blood sample for the Test(s) at a PSC.
- You understand that, as with all laboratory tests, there is a chance of a false positive or false negative result.
- The Services are provided for informational purposes, and do not constitute treatment of any condition, disease, or illness. Providers (as defined below) will not prescribe or order any medication or devices in connection with the Services.
- You are responsible for sharing your Test results (“Results”) with your healthcare provider and for following up with your healthcare provider for care, diagnosis, and/or medical treatment.
- Providers do not replace your existing primary care or other relationship with your physician or other healthcare provider. You agree that you will not make medical decisions without consulting a healthcare provider. You will not disregard advice from your healthcare provider or delay seeking advice from a healthcare provider based on information provided as a result of the Tests or the Services.
- You understand that your health information and results may be shared as described in the Privacy Policy and the Clinician Group Notice of Privacy Practices.
- If your Results are provided to you via the Portal, you are responsible for checking for Results notification and logging on to your account to view your Results when available.
- You may be provided with the opportunity to connect to an independent healthcare provider for follow-up services and/or treatment. Any such services are not part of the Services hereunder and may be subject to additional fees.
- To the extent you are offered any additional products or services, you understand that such products or services are not part of the Services.
- You understand that the Services are currently offered on a self-pay basis only and are not eligible for reimbursement by any health insurance plan. You may not submit a claim to your health plan for coverage of the Services. However, you may use an HSA/FSA debit card for payment or submit a claim to your HSA/FSA administrator, subject to their individual reimbursement policies. The Services are not intended to establish medical necessity for insurance purposes.
- You understand that a portion of the total purchase price may include fees for services provided by Partners, including the Clinical Group fee for an independent Provider to provide clinical oversight and the Lab fee for laboratory services. Payment for the PromarkerD test may be processed directly by the test provider. RoseRx acts as a billing agent only for certain Partners and collects fees for such services on their behalf. You understand that testing is voluntary and that you may withdraw your consent to testing at any time prior to the completion of the Test(s) by contacting contact@roserx.health.
- You understand that if you have any clinical or other questions before or after your Test, you may contact contact@roserx.health.
Messaging
You consent to be contacted by RoseRx and/or its Partners at the phone number, mobile number, email address, and address that you provide, including calls, text messages, and other messaging relating to the Services and follow-up, including customer surveys. You understand and agree that such messages may include personal health information about the Test(s) and your Results. You understand that it is your responsibility to monitor and respond to these messages and emails and that you are responsible for notifying contact@roserx.health of any changes to your contact information.
Technology Services
In order to provide the Services, RoseRx will provide a technology platform, including the Portal, as well as facilitation of access to laboratory and clinical services. By using the Services, you grant RoseRx the right, power, and authority to act on your behalf to access and transmit your information for the purpose of facilitating the performance of the Services, including laboratory testing services. You agree to and authorize RoseRx to transfer, store, and process your data in accordance with the Privacy Policy and any data authorization to which you have consented.
Laboratory Services
You acknowledge that RoseRx is not a laboratory and does not perform any testing on your sample. RoseRx enables you to access independent laboratories for laboratory testing services. The laboratory Partner (the “Lab”) performing the laboratory services for a Test is identified on the Portal. The Lab is solely responsible for all of the laboratory services provided in connection with the Test. Such services are subject to any Lab policies provided to you by the Lab.
Virtual Care Services
You acknowledge that RoseRx is not a healthcare provider and does not provide medical, health, or other professional services or advice. RoseRx enables you to access independent healthcare providers for clinician oversight for the Test through a Partner, CWI Physician Partners P.C., an independent entity, its contractually affiliated professional entities, and its affiliated clinicians (collectively “Clinician Group”). Clinician Group’s affiliated providers (each, a “Provider”) provide clinician oversight, including ordering, where appropriate, for the Tests. You acknowledge that Providers are not employees of RoseRx and are not providing services on behalf of RoseRx, but instead are independent professionals solely responsible for the services each provides to you.
Withdrawal of Consent
You understand that your use of the Services is voluntary. You may choose to withdraw your consent or stop using the Services at any time. Such requests should be sent to contact@roserx.health.
Acknowledgement
By clicking “I accept”:
(i) you acknowledge and accept any risks associated with the Tests and the Services,
(ii) you knowingly and voluntarily acknowledge and consent to the terms of the Services,
(iii) you represent and warrant that you have the legal right, on behalf of yourself or a minor child of whom you are a parent or legal guardian, to give informed consent to receive the Services, and
(iv) you give your informed consent to receive the Services.
CWI PHYSICIAN PARTNERS “CYNERGY WELLNESS” INFORMED CONSENT
Authorization and Consent for Diagnostic Testing
- I voluntarily consent and authorize:
- CWI Physician Partners P.C., a California Professional Corporation
- CWI Physician Partners P.C., a Hawaii Professional Corporation
- CWI Physician Partners P.C., a Georgia Professional Corporation
- CWI Physician Partners P.A., a Kansas Professional Association
- CWI Physician Partners P.C., an Oregon Professional Corporation
- CWI Physician Partners P.C., a Nevada Professional Corporation
- CWI Physician Partners P.C., a Rhode Island Professional Corporation
- CWI Physician Partners P.C., an Oklahoma Professional Corporation
to review the collection, testing, and analysis for the purposes of a diagnostic screening test. I understand that there are risks and benefits associated with undergoing a diagnostic screening testing and there may be a potential for false positive or false negative test results. I assume complete and full responsibility to take appropriate action with regards to my test results. Should I have questions or concerns regarding my results, or a worsening of my condition, I shall promptly seek advice and treatment from an appropriate medical provider.
I further acknowledge:
a) I am the individual who will provide the sample for the Test(s) that I am requesting.
b) I am at least eighteen (18) years of age.
c) I have read and understand the information provided about the Test(s) that I have been provided
d) on the website where I requested the Test.
e) The information I have provided in connection with my request to CWI is correct to the best of my knowledge. I will not hold CWI or its employees or agents responsible for any errors or omissions that I may have made in providing such information.
f) My health information and results may be shared with CWI employees and agents for the purpose of ordering, processing, and reporting my results.
g) Medical Services provided by CWI are purely for diagnostic assistance purposes and do not create a physician-patient relationship, and do not constitute medical care or diagnosis or treatment of any condition, disease, or illness.
h) I authorize CWI to contact me via text message to communicate with me regarding my test.
- Patient Rights and Privacy Practices
a) Notice of Privacy Practices and Patient Rights:
CWI Physician Partners P.C. Notice of Privacy Practices describes how it may use and disclose your protected health information for other purposes that are permitted or required by law. To review a copy of CWI Physician Partners P.C. Notice of Privacy Practices, go to www.CynergyWellness.com.
b) Disclosure to Government Authorities:
I acknowledge and agree that my test results and associated information may be disclosed to appropriate county, state, or other governmental and regulatory entities as may be permitted by law.
- Release
a) To the fullest extent permitted by law, I hereby release, discharge and hold harmless, CWI including, without limitation, any of its respective officers, directors, employees, representatives and agents from any and all claims, liability, and damages, of whatever kind or nature, arising out of or in connection with any act or omission relating to my diagnostic test or the disclosure of my test results.
b) By selecting the I ACCEPT THE TERMS OF SERVICE during the registration and check-out process for diagnostic testing, I acknowledge and agree that I have read, understand, and agreed to the statements contained within this form. I have read the contents of this form in its entirety and voluntarily consent to proceed with these procedures.
CWI Physician Partners P.C.
16445 Westgate
Overland Park, KS 66221
Effective Date: May 3, 2024
Last Update: May 3, 2024