FRM 16.1-1-3

IMPORTANT DISCLAIMER FOR VOLUNTARY PARTICIPATION IN HELIUS REGISTRY PROGRAM (REGISTRY)

Helius’s Registry Program Voluntary Participation: “You have the opportunity to elect and participate in Helius’s upcoming registry program (the “Registry”) by selecting ‘Yes’ on the GetPonsTherapy.com registration page. The Registry will be designed to gather, over a period of eighteen [18] months, important health economic information to establish the value of the PoNS Device on key therapeutic outcomes including disease-associated injury risks (i.e, falls), onset of new comorbidities and/or worsening/improvement of existing medical condition(s) (other than gait deficit/impairment), need for new pharmacological/non-pharmacological intervention or increase/decrease of ongoing pharmacotherapy or other non-pharmacological intervention, increase/decrease of in-patient/out-patient hospital and/or office visits or stays, side effects. By participation in the Registry, you will be providing Helius with access to information on your medical history, medical diagnoses, clinical symptom presentations, medications, pharmacologic and non-pharmacologic prescriptions, hospitalization and healthcare visits, any reported therapy’s adverse events. Participation in the Registry is voluntary and your participation in the Program is not dependent upon your agreement to participate in the Registry.”