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Dear Tarley Samwell, please complete this one-time Patient Consent to Treatment form for instED visits, by clicking the link below. Do not forget to click SUBMIT when you are done. Click here to complete the form: https://insted-patient-qa.vicenna.com/patient-consent/consent-detail-form?token=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJjbGllbnRVc2VyIjoiVHJ1ZSIsIlBlcm1pc3Npb24iOiJJbnMuRGVmYXVsdC5BbGxVc2VycyIsImNvbnNlbnRJZCI6IjY5ZjliZTU1ZjU2Y2MwMjQ2YjJkMDUxNiIsInBhdGllbnRMYXN0TmFtZSI6IlRhcmxleSIsInBhdGllbnRGaXJzdE5hbWUiOiJTYW13ZWxsIiwicHJlZmVycmVkTGFuZ3VhZ2UiOiJlbiIsImV4cCI6MTgwOTUxMTIxMX0.j3Zks3KFyG9wUJc0eZzdjx2hrJvM7kOHUNLoHTurJg0 For any questions or comments please call instED at 833-946- 7833 , from 8:00 AM to 10:00 PM (ET).

Dear Tarley Samwell, please complete this one-time Patient Consent to Treatment form for instED visits, by clicking the link below. Do not forget to click SUBMIT when you are done. Click here to complete the form: https://insted-patient-qa.vicenna.com/patient-consent/consent-detail-form?token=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJjbGllbnRVc2VyIjoiVHJ1ZSIsIlBlcm1pc3Npb24iOiJJbnMuRGVmYXVsdC5BbGxVc2VycyIsImNvbnNlbnRJZCI6IjY5ZjliZTU1ZjU2Y2MwMjQ2YjJkMDUxNiIsInBhdGllbnRMYXN0TmFtZSI6IlRhcmxleSIsInBhdGllbnRGaXJzdE5hbWUiOiJTYW13ZWxsIiwicHJlZmVycmVkTGFuZ3VhZ2UiOiJlbiIsImV4cCI6MTgwOTUxMDg2OX0.GEVppZZiM8oF7Ps3NLPHIVCCm0JWKz65VIZCof8m0f8 For any questions or comments please call instED at 833-946- 7833 , from 8:00 AM to 10:00 PM (ET).

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Dear Tarley Samwell, please complete this one-time Patient Consent to Treatment form for instED visits, by clicking the link below. Do not forget to click SUBMIT when you are done. Click here to complete the form: https://insted-patient-qa.vicenna.com/patient-consent/consent-detail-form?token=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJjbGllbnRVc2VyIjoiVHJ1ZSIsIlBlcm1pc3Npb24iOiJJbnMuRGVmYXVsdC5BbGxVc2VycyIsImNvbnNlbnRJZCI6IjY5ZjliN2ZhZjU2Y2MwMjQ2YjJkMDUwMiIsInBhdGllbnRMYXN0TmFtZSI6IlRhcmxleSIsInBhdGllbnRGaXJzdE5hbWUiOiJTYW13ZWxsIiwicHJlZmVycmVkTGFuZ3VhZ2UiOiJlbiIsImV4cCI6MTgwOTUwOTM2MH0.Phe7keHTczN2NfsWiUdbAcxN1_ZDh0yQcuo44bHp7Fs For any questions or comments please call instED at 833-946- 7833 , from 8:00 AM to 10:00 PM (ET).

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