The following are examples of some of the possible minor risks/adverse reactions reported for the peptide therapy that may be prescribed for me. At prescribed doses, there are not expected to be any signiﬁcant risks/adverse reactions as long as full medical disclosure is achieved from the patient during the total time of therapy.
Some adverse reactions may include but are not limited to injection site redness, ﬂushing, transient high blood sugar, development of antibodies peptides, and water retention. These side eﬀects are dose related and usually eliminated by adjusting the dosage. This drug should not be used in patients with known cancer or are pregnant.
By signing this form, I understand the possible risks associated with this treatment.
I understand that Dr. Grover and his medical staff will monitor my treatment in an eﬀort to manage any side eﬀects, but cannot guarantee that I will not experience any side eﬀects or adverse reactions.
I understand that, as with any health treatment, there is no guarantee I will obtain satisfactory results through the use of this therapy.
I certify that I have read the foregoing Informed Consent, discussed the issues noted above, had opportunities to ask questions, and agree and accept all of the terms above.