REFLEO HEALTH, INC.

YOUNG PERSON'S ACKNOWLEDGMENT

Name: Refleo
Price: 100.00 USD

From the Refleo Health Parental Consent and Authorization, form version 1.0

To be completed by the young person where they are able to do so.

I understand that I will be recording entries about how I am doing, and that my clinician will read or listen to them. I understand that Refleo is not a person and will not answer me. I understand that if I need help right away, I should call or text 988, call 911, or tell an adult.