Consent for Testosterone Replacement/ HCG Therapy/ Other Therapy Agreement
It is important to understand that all medicine is an inexact science. Although we will carry out your treatment carefully, results may vary in their degree of success. It is quite natural for a patient undergoing Testosterone Replacement Therapy to want to know that everything will turn out all right. While most of the time this is the case, it is very important for you to be aware of the potential risks, as well as the benefits, expected from the treatment when deciding on whether to begin Testosterone Replacement Therapy. You should also be aware of the alternatives to Testosterone Replacement Therapy, including not receiving the treatment. It is important that you consider the information we have provided you. Be sure that you are doing what is right for you. If you are unsure, then perhaps you should take some time to weight your options or consult another health care provider. Please review the following statements, which discuss informed consent.
Any questions that you may have should be brought to our attention. Your clinical provider will attempt to answer all your questions to your satisfaction.
I agree that, while a patient of Quintessence Health & Wellness, LLC., I will not take any type of anabolic steroids, testosterone gels, hormone “boosters,” pro-hormones or any additional testosterone supplementation not provided by Quintessence Health & Wellness LLC. during my treatment plan. At any time, if use of these items is discovered, I understand I will be discharged as a patient of Quintessence Health & Wellness. And the information I have provided is true and accurate to the best of my knowledge.