PURPOSE OF THIS CONSENT
This consent form is intended to inform you, the patient, about the potential benefits, risks, limitations, and alternatives to peptide therapy. Please read it carefully and ask any questions you may have before signing.
WHAT ARE PEPTIDES?
Peptides are short chains of amino acids that function as signaling molecules in the body. They may influence physiological processes including hormone regulation, tissue repair, immune function, metabolism, and neurological health. Some peptides are FDA approved for specific uses, while many are considered investigational or used off label in clinical settings.
TREATMENT OVERVIEW
Your provider has recommended peptide therapy based on your medical history, symptoms and laboratory results. Peptides may be administered via subcutaneous injection, oral capsule, topical cream, nasal spray, or other methods depending on your treatment plan.
OFF LABEL AND INVESTIGATIONAL USE
Many peptides used in therapy are not approved by the US Food and Drug Administration (FDA) for all intended uses. The treatment being recommended may be considered off label or investigational, meaning the use is based on emerging research and clinical experience, not definitive FDA approval for the specific purpose.
POTENTIAL BENEFITS
Potential benefits of peptide therapy may include:
Enhanced tissue healing and repair.
Improved energy, endurance, and performance
Better sleep quality and mood regulation
Cognitive and immune system enhancement
*Please note: Individual results vary. No guarantees can be made regarding specific outcomes.
RISKS AND SIDE EFFECTS
As with any treatment, peptide therapy carries potential risks, which may include:
Redness, swelling or irritation at injection sites
Headaches, nausea, dizziness
Fatigue or mood changes
Allergic reactions
Hormonal fluctuations
Unknown or long term adverse effects, particularly for investigational compounds.
It is your responsibility to report any side effects to your provider immediately.
ALTERNATIVES
Alternative to peptide therapy include:
Traditional medical therapies
Hormone replacement therapy
Lifestyle changes and nutritional support
Choosing not to pursue treatment at this time
You are encouraged to discuss these options with your provider before making a decision.
VOLUNTARY PARTICIPATION
Your participation in peptide therapy is completely voluntary. You have the right to discontinue therapy at any time without penalty or loss of access to care.
PATIENT RESPONSIBILITES
By proceeding with therapy, you agree to:
Follow the provider’s instructions and dosing protocols
Report any side effects or new symptoms
Undergo recommended follow-up and lab testing
Avoid sharing or misusing peptides in any way
CONSENT AND RELEASE
By signing below, I acknowledge that:
I have read and fully understand this consent form.
I have had the opportunity to ask questions, and all questions were answered to my satisfaction.
I understand the investigational nature and possible risks of peptide therapy.
I understand that no guarantees have been made regarding results.
I voluntarily consent to proceed with peptide therapy
I hereby release New You Weight Loss & Wellness Center, its providers, and staff from liability related to the use of peptide therapy, except in cases of gross negligence or malpractice.