HAWA 360 LLC · Medical Weight Management Services
Please read all sections before enrolling. You will be asked to sign or acknowledge each one. You may download and keep a copy of every document, and you may request a copy at any time at no charge.
Hawa 360 is not a medical practice and does not practice medicine. Hawa 360 LLC operates the technology platform and handles scheduling, records, billing, and customer support. Medical care is provided by independently licensed physicians who exercise their own judgment. Hawa 360 does not direct their clinical decisions.
Paying for a membership does not entitle you to a prescription. Your physician may determine that medication is not appropriate for you, or that you should be seen in person instead. If that happens, you have not done anything wrong, and Section 6 of the Patient Membership and Services Agreement explains what you are refunded.
This service is not for emergencies. If you are having a medical emergency, call 911 or go to the nearest emergency department. Do not use the Hawa 360 platform to report an emergency.
Hawa 360 LLC
This Patient Membership and Services Agreement (the "Agreement") is between you ("you" or "Patient") and Hawa 360 LLC, an Indiana limited liability company ("Hawa 360," "we," or "us"). It takes effect when you accept it electronically and enroll. Please read it carefully and keep a copy.
Hawa 360 operates a technology platform (the "Platform") through which you can obtain medical weight management services from independently licensed physicians. Hawa 360 provides administrative and technology services only: intake, scheduling, the electronic health record, encounter infrastructure, prescription routing, payment processing, records handling, and customer support.
Hawa 360 does not practice medicine, does not employ the physicians who treat you, does not direct or control their clinical decisions, and does not dispense or sell medication. Physicians who provide care through the Platform are independent contractors who exercise independent professional judgment and are responsible for the medical care they provide. Medication, if prescribed, is dispensed by a licensed pharmacy, which is a separate business.
Your physician-patient relationship is with the treating physician, not with Hawa 360.
To enroll, you must:
You must tell us if you move or travel to a different state, because your physician may not be licensed there and may not be able to treat you until that is resolved.
You are purchasing a membership that includes [DESCRIBE INCLUSIONS]. The specific inclusions, term, and price of your plan are shown at checkout before you pay and in your confirmation email.
You are not purchasing medication, a prescription, a specific medication, a specific dose, or a particular outcome. You are purchasing access to a clinical evaluation and to ongoing care if the physician determines that care is appropriate.
Hawa 360 makes no representation, warranty, or guarantee about the amount of weight you will lose, how quickly you will lose it, whether you will maintain any loss, or whether treatment will improve any health condition. Results vary substantially between individuals. Weight regain after stopping medication is common. Any figures appearing in advertising reflect results reported in clinical studies or by individual patients and are not a prediction of your result.
Hawa 360 is a cash-pay service. We do not bill Medicare, Medicaid, TRICARE, or any commercial health insurer, and we do not submit claims on your behalf. Medicare and Medicaid beneficiaries may enroll but should understand that no portion of the fee will be billed to or reimbursed by those programs.
You authorize Hawa 360 and its payment processor to charge the payment method you provide for the amounts and at the intervals disclosed at checkout. Charges are made in advance of each billing period.
AUTOMATIC RENEWAL. Your membership renews automatically every [INTERVAL] at [PRICE] until you cancel. You may cancel at any time. Cancellation takes effect at the end of the current billing period.
You may request an itemized statement or superbill for your own use in seeking reimbursement from a health savings account, flexible spending account, or out-of-network benefit. We cannot guarantee that any account administrator or insurer will accept it.
If a payment fails, we may retry it and may suspend services until payment is received. You agree to keep your payment information current.
Your physician may determine that weight management medication is not appropriate for you, that you need laboratory testing or an in-person evaluation first, or that treatment should be stopped. This is a medical decision and Hawa 360 will not override it.
If your physician declines to prescribe at your initial evaluation, you will be refunded [DESCRIBE]. If your physician discontinues treatment mid-term, you will be refunded a prorated portion of the unused medication and service period as described in Section 7.
If you believe you were charged in error, contact us at [EMAIL] before initiating a chargeback. We will investigate promptly. Initiating a chargeback does not cancel your membership; you must also cancel using the methods above.
This service is not appropriate for emergencies. If you are experiencing severe abdominal pain, persistent vomiting, signs of an allergic reaction, chest pain, difficulty breathing, thoughts of harming yourself, or any other emergency, call 911 or go to the nearest emergency department immediately. Do not send a message through the Platform and wait for a reply.
If you are in emotional distress or having thoughts of suicide, call or text 988 (the Suicide and Crisis Lifeline) at any time.
Hawa 360 maintains your medical record and serves as custodian of records generated through the Platform. You may request a copy of your record at any time, in the format you prefer where readily producible, as described in the Notice of Privacy Practices. Records are retained as required by applicable state and federal law.
By enrolling you agree to receive service-related communications, including appointment reminders, clinical messages from your physician, shipping notices, and billing notices. Marketing communications require separate consent and can be withdrawn at any time.
Nothing in this Agreement limits, waives, or releases any claim you may have against any physician or other licensed professional for the medical care they provide to you, or against any pharmacy for the medication it dispenses. You are not giving up any right to bring a professional negligence claim.
Subject to the paragraph above, and to the maximum extent permitted by law, Hawa 360's liability to you for claims arising out of its own administrative and technology services—including Platform availability, scheduling, billing, and record handling—is limited to the total amount you paid Hawa 360 in the twelve months preceding the event giving rise to the claim. Hawa 360 is not liable for indirect, incidental, consequential, or punitive damages arising from those services.
The Platform is provided on an "as available" basis. Internet and software failures can occur. Hawa 360 does not warrant that the Platform will be uninterrupted or error-free, but this does not limit any obligation Hawa 360 has to safeguard your health information or to maintain your records.
Some states do not allow certain limitations of liability, and those limitations do not apply to you to the extent prohibited. Nothing here limits liability for gross negligence, willful misconduct, fraud, or any liability that cannot be limited by law.
PLEASE READ. THIS AFFECTS YOUR LEGAL RIGHTS. Most disputes between you and Hawa 360 must be arbitrated individually. You waive a jury trial and class participation for those disputes. This does not apply to any medical malpractice or professional negligence claim against a physician or other provider. You may opt out within 30 days, and your care will not be affected.
13.1 Agreement to Arbitrate.You and Hawa 360 LLC agree that any dispute between you arising out of or relating to this Agreement, your membership, the Platform, fees, billing, automatic renewal, cancellation, refunds, advertising, or the handling of your records or personal information (a "Covered Claim"), whether in contract, tort, statute, or otherwise, will be resolved by binding individual arbitration and not in court. This Section does not apply to any claim against a physician or other licensed provider arising out of medical malpractice, or to any claim against Hawa 360 based on such a provider's alleged professional negligence, including vicarious liability, apparent agency, negligent credentialing, and negligent supervision; all such claims proceed under the Indiana Medical Malpractice Act, Ind. Code art. 34-18, and nothing here waives or restricts any right or remedy you have under that Act or the Indiana Patient's Compensation Fund. All claims not governed by the Indiana Medical Malpractice Act are subject to binding arbitration under this Agreement. This Section also does not apply to your right to report to or cooperate with any government or licensing authority. Before starting arbitration, the party raising a Covered Claim must give the other written notice and thirty (30) days to resolve it informally; applicable limitations periods are tolled during that period and are not otherwise shortened by this Section.
13.2 Class Action Waiver. Covered Claims must be brought only in an individual capacity. Neither party may bring a Covered Claim as a plaintiff or class member in any purported class, collective, consolidated, representative, or private attorney general proceeding, and the arbitrator may not consolidate the claims of more than one person or preside over any representative proceeding, unless both parties agree in writing after the dispute arises. This paragraph is not severable from the remainder of Section 13. If the class action waiver is held unenforceable as to any claim or request for relief, Section 13 does not apply to that claim or request, which will proceed in court, and the remainder of Section 13 continues to govern all other Covered Claims.
13.3 Procedure; Opt-Out; Governing Law.Arbitration will be administered by the American Arbitration Association under its Consumer Arbitration Rules before a single neutral arbitrator, who may award any relief a court could award on the same claim and will issue a written reasoned award. You and Hawa 360 expressly agree to abide by and be bound by the arbitrator's award, which is final and binding, and judgment may be entered on it in any court of competent jurisdiction. Hawa 360 will pay all filing, administrative, and arbitrator fees above what you would pay to file the same claim in an Indiana state court. At your election the arbitration will proceed by videoconference, on documents only, or in person in your county of residence. Arbitration is not a condition of enrolling or of receiving care, and you may opt out within thirty (30) days of accepting this Agreement by written notice to Hawa 360 LLC, Attn: Legal, [ADDRESS] or [EMAIL]; opting out is free, affects nothing else in this Agreement, and will not affect your care. This Section survives termination.
We may change this Agreement. If a change is material—including any change to price, billing frequency, cancellation terms, or dispute resolution—we will notify you by email at least 30 days in advance, and the change will apply only to billing periods beginning after that notice. You may cancel before the change takes effect. Continuing your membership after the effective date means you accept the change.
We may suspend or terminate your membership for non-payment, for providing false information, for abusive conduct toward staff or providers, or where continuing is unlawful. If we terminate, we will refund any prepaid, unused service period. Termination of your membership does not terminate your physician's professional obligations to you, and your physician will arrange appropriate follow-up or referral consistent with professional standards.
If any provision of this Agreement is unenforceable, the rest remains in effect. Our failure to enforce a provision is not a waiver. You may not assign this Agreement. This Agreement, together with the accompanying consents and disclosures, is the entire agreement between you and Hawa 360 regarding the Platform and membership.
By signing, I confirm that I have read and understood the Patient Membership and Services Agreement, including the automatic renewal terms in Section 5 and the cancellation and refund terms in Section 7.
This document explains what telehealth is, what it can and cannot do, and to what you are agreeing. Please read it before your first encounter. Your physician may also review it with you.
Telehealth means receiving medical care from a physician who is not physically in the room with you. Through Hawa 360, care may be delivered by:
Which method is used depends on what your physician judges to be clinically appropriate and on what the law of your state permits. Some states require a live video encounter before a prescription can be issued. Your physician will tell you if a live encounter is required.
Telehealth can give you access to care without travel, often with shorter waits and more scheduling flexibility, and allows you to be treated from a private location of your choosing.
Telehealth is not the same as an in-person visit, and it has real limitations. You should understand the following:
Your physician must be licensed in the state where you are physically located at the time of each encounter — not where you live, and not where the physician is. You must tell us your location truthfully at the start of each encounter. If you are traveling, care may be unavailable until you return or until a licensed physician can be assigned.
You do not have to use telehealth. You may seek in-person care from a physician or clinic in your area, and you may stop using telehealth at any time without affecting your right to obtain care elsewhere. Your physician can discuss whether in-person care would be preferable for you.
Hawa 360 does not record video or audio of clinical encounters. You may not record an encounter without your physician's consent.
Telehealth is not for emergencies. If you have a medical emergency, call 911 or go to the nearest emergency department. At the start of each live encounter your physician will confirm your physical location so that emergency services can be directed to you if needed.
Telehealth works best alongside, not instead of, a relationship with a primary care provider. With your permission, your physician can send records of your care to your primary care provider, and we encourage that.
I have read this document. I have had the opportunity to ask questions and my questions have been answered. I understand the benefits, limitations, and risks of telehealth described above, and I consent to receive care by telehealth through the Hawa 360 platform.
Weight Management Treatment with GLP-1 Receptor Agonist Medication
This document describes the treatment being offered, its known risks, and what is required of you. It is long because the risks matter. Please read all of it, initial each item in Section 5, and ask your physician about anything that is unclear. You may decline this treatment at any time.
GLP-1 receptor agonists (including semaglutide and tirzepatide, which also acts on the GIP receptor) are injectable medications that mimic hormones your body produces after eating. They slow the emptying of the stomach, reduce appetite, and increase the feeling of fullness. They are used together with reduced calorie intake and increased physical activity. They are not a substitute for those changes.
The specific medication your physician may prescribe, its dose, and how it is given will be discussed with you individually. Your physician may prescribe a medication for a use that is not among its FDA-approved indications if, in their professional judgment, it is appropriate for you. This is lawful and common, and your physician will tell you if that is the case.
Treatment usually begins at a low dose that is increased gradually over weeks or months to reduce side effects. Weight loss is gradual. Results vary widely, and some people lose little or no weight. Ongoing follow-up is part of treatment, not optional.
Most people who stop taking these medications regain a substantial portion of the weight they lost. Long-term treatment may be necessary to maintain results. You should consider whether this is something you are prepared to continue before starting.
Nausea, vomiting, diarrhea, constipation, abdominal pain, bloating, gas, heartburn, burping, reduced appetite, fatigue, headache, dizziness, and injection site reactions such as redness, itching, or swelling. Gastrointestinal effects are most pronounced when starting and after each dose increase, and usually lessen over time.
These medications are not to be used during pregnancy. Animal studies have shown harm to the fetus, and human data are limited. If you can become pregnant, you should use effective contraception. Because these medications slow stomach emptying, oral contraceptives may be absorbed less reliably, particularly with tirzepatide; your physician may advise a non-oral method or a backup method during dose increases. Tell your physician immediately if you become pregnant or intend to. If you are breastfeeding, discuss this with your physician before starting.
Slowed stomach emptying can change how quickly other oral medications are absorbed. This matters most for medications where timing or blood level is critical. Give your physician a complete list of everything you take, including over-the-counter products, supplements, and herbal remedies.
These medications are generally not appropriate if you have or have had medullary thyroid carcinoma or Multiple Endocrine Neoplasia type 2 (personally or in your family), a serious allergic reaction to the medication, or pregnancy. Caution or alternative treatment may be warranted with a history of pancreatitis, gallbladder disease, gastroparesis or significant gastrointestinal disease, type 1 diabetes, severe kidney or liver disease, diabetic retinopathy, or an eating disorder. Your physician will evaluate your individual situation. Only your physician can decide whether this treatment is appropriate for you.
______ I understand that GLP-1 medication is intended to be used together with reduced calorie intake and increased physical activity, and is not a substitute for them.
______ I understand that individual results vary widely, that no particular amount of weight loss has been promised to me, and that weight regain after stopping is common.
______ I have read the risks in Section 3, including the boxed warning regarding thyroid C-cell tumors, and pancreatitis, gallbladder disease, bowel obstruction, and anesthesia-related aspiration risk.
______ I understand I must tell any surgeon, anesthesiologist, dentist, or proceduralist that I am taking this medication before any procedure involving sedation or anesthesia.
______ I have given my physician a complete and truthful medical history, including all medications, supplements, allergies, prior surgeries, and personal and family history of thyroid cancer, pancreatitis, gallbladder disease, and eating disorders.
______ I understand this medication must not be used during pregnancy, and if I can become pregnant I will use effective contraception and tell my physician immediately if I become pregnant or intend to.
______ I agree to attend follow-up encounters and to complete any laboratory testing my physician orders.
______ I agree to report side effects and new symptoms promptly, and to seek emergency care for severe abdominal pain, persistent vomiting, signs of allergic reaction, or thoughts of harming myself.
______ I will use this medication only as prescribed, only for myself, and will not share it. I will store and dispose of medication and needles safely as instructed.
______ I will not obtain the same or a similar medication from another source at the same time without telling my physician.
______ I understand my physician may decline to prescribe, may change my dose, or may stop treatment at any time based on their medical judgment, and that paying for a membership does not entitle me to a prescription.
______ I understand that the medication prescribed to me is a compounded preparation, that compounded drugs are not FDA-approved and have not been evaluated by FDA for safety, effectiveness, or manufacturing quality, and that my physician has discussed with me why a compounded product is being used and what the alternatives are.
Alternatives include lifestyle and behavioral programs with or without a dietitian, other weight management medications, bariatric surgery, treatment of underlying conditions contributing to weight, and choosing no treatment. Each has its own risks and benefits. Your physician can discuss which alternatives may suit you.
Report side effects to your physician through the Platform. You may also report side effects directly to the FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
I have read this document in full. I have had the opportunity to ask questions and my questions have been answered to my satisfaction. I understand the risks, benefits, limitations, and alternatives, and I voluntarily consent to treatment.
Hawa 360 LLC
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective date: ______________________
Hawa 360 LLC is required by law to maintain the privacy of your protected health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect. We are also required to notify you if a breach affects your unsecured protected health information.
You may revoke an authorization in writing at any time, except to the extent we have already acted on it.
If you believe your privacy rights have been violated, you may complain to us at [PRIVACY OFFICER NAME, ADDRESS, EMAIL, PHONE], or to the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201, or at www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.
We may change this notice and make the new terms effective for all information we maintain. The current notice will always be posted at [URL] with its effective date.
You consent to receive this package and all related documents, notices, and disclosures electronically, and to sign them electronically. Your electronic signature has the same legal effect as a handwritten one.
To access and keep these records you need a device with internet access, a current web browser, an active email address, and the ability to view and save PDF files. You may withdraw consent to electronic records at any time by contacting [EMAIL]; withdrawal does not affect the validity of records already provided. You may request a paper copy of any document at no charge.
We will contact you by email, secure message through the Platform, and, if you provide a mobile number, by text message, regarding appointments, clinical messages from your physician, prescriptions and shipments, billing, and account matters. These are not marketing messages and are part of the service you enrolled in.
Standard message and data rates may apply. Reply STOP to any text message to stop text messages; you will continue to receive email and Platform messages necessary to your care.
Optional — check to consent. This is not required to receive care.
☐ I consent to receive marketing emails from Hawa 360 about products, services, and promotions.
☐ I consent to receive marketing text messages, including messages sent using an automatic telephone dialing system, from Hawa 360 at the mobile number I provide.
Consent to marketing messages is not a condition of purchase or of receiving care. You may withdraw consent at any time by using the unsubscribe link, replying STOP, or contacting [EMAIL].
Email and standard text messages are not fully secure. We limit health information in these channels and use the secure Platform for clinical detail. Messages sent to the address or number you give us may be seen by anyone with access to that device or account. Tell us if you want us to use a different method.
Return to the checkout and intake portal to complete your enrollment.