A. Background:
Semaglutide (sometimes sold under the brand names Ozempic or Wegovy) is an injectable or sublingual medication that, when used in combination with a low-calorie diet and exercise, helps with chronic weight management in adult patients. It can also be used for individuals with increased risk for Cardiometabolic diseases such as heart attack, stroke, and Type 2 diabetes. Semaglutide belongs to a class of medications called glucagon-like peptide-1 (GLP-1) agonists,which mimic the hormone GLP-1 in your body. This hormone slows down how fast your stomach empties food (called gastric emptying), stimulates your pancreas to release insulin (lowering blood sugar levels),and it blocks a hormone that causes your liver to release sugar (glucagon).Together, these functions can help you feel less hungry, causing you to eat less food and lose weight. Like other prescription weight-loss drugs, Semaglutide is intended to be used as part of an overall weight-loss plan. It is indicated for people who are obese or overweight, and who have failed to lose enough weight with diet and exercise alone — not for people who want to lose just a few pounds.
B. Possible Benefits:
Possible benefits of Semaglutide include fat loss, weight loss, improved self-image, improved self-esteem, and improved cardiometabolic risk factors.
C. Alternatives to Treatment
Alternatives to Semaglutide treatment include diet and exercise alone, other weight loss prescription medications, or procedure-based weight loss methods including gastric banding or bypass.
D. Potential Risks and Contra-indications:
Semaglutide is considered safe and effective when used as indicated. But safe doesn’t mean that there aren’t risks. Semaglutide carries a boxed warning about thyroid C-cell tumors occurring in rodents and Multiple Endocrine Neoplasia Type 2, and it shouldn’t be used if you or your family have a history of certain thyroid cancers or Multiple Endocrine Neoplasia Type 2. Semaglutide should not be used in people with Type-1 diabetes or a history of pancreatitis. Semaglutide should be used cautiously for people on other blood-sugar-lowering medications. Patients may experience significant drops in blood sugars when using Semaglutide.
Although side effects are minimal for most people who follow the Treatment protocol, common potential side effects of Semaglutide include nausea, diarrhea, vomiting, constipation, stomach(abdomen) pain, headache, tiredness (fatigue), upset stomach, dizziness, feeling bloated, belching, gas, and heartburn. Rare, but potential side effects include acute pancreatitis, acute gallbladder disease, hypoglycemia, acute kidney injury, diabetic retinopathy, heart rate increase, and suicidal ideation. Semaglutide usage has also been associated with gastroparesis which is where the stomach stops its normal movement (peristalsis) and causes the patient to vomit uncontrollably. Rare cases can lead to hospitalization from dehydration and esophageal bleeding.Semaglutide may cause fetal harm. When pregnancy is recognized, discontinue Semaglutide immediately. Discontinue Semaglutide at least 2 months before a planned pregnancy because of the long half-life of the medication.By signing below, I acknowledge and agree as follows: My clinical team at H2O2U Mobile IV Services LLC will not monitor the blood sugars of a non-diabetic patient. I will take the medication only as directed by the medical provider according to the treatment guidelines established. I understand the risks associated with treatment, and that not complying with the dosage recommendations and dietary restrictions could increase risks and alter the results. Product information is available upon request. H2O2U Mobile IV Hydration Services LLC works in conjunction with, but cannot replace, my primary care physicians, general practitioners or other specialists in Family Medicine or Internal Medicine.
E. Payment Obligation:
H2O2U Mobile IV Hydration Services LLC is committed to enabling its patients to obtain and maintain health and wellness naturally based upon a natural and preventative approach that are rarely covered by insurance companies. For this reason, H2O2U Mobile IV Hydrations Services LLC does not accept or bill insurance for this treatment. I acknowledge that my provider will not pre-certify treatment with my insurance Brand or answer letters of appeal, and that I am solely responsible for the cost of Treatment.
Once treatment is started, H2O2U Mobile IV Hydration Services LLC cannot honor any refund requests based on scheduling conflicts, missed doses, or unsatisfactory results. I understand that paymentis due in full at the time of service. I also understand that it is my responsibility to submit a claim to my insurance Brand for possible reimbursement. I have been advised that H2O2U Mobile IV Hydration Services LLC does not expect that treatment is a covered benefit under my insurance benefit programs.
F. Informed Consent to Treatment:
By knowingly and voluntarily signing my name below, I hereby certify that:
• I am at least 18 years old;
• I have received verbal or written information about Semaglutide;
• I have disclosed and discussed any and all health conditions or changes in my healthcondition since my last visit with my provider;
• I want to proceed with and will follow the recommended course of care for Semaglutide weight loss injections that are described in this Informed Consent, together with the related care associated therewith;
• I have been advised of and understand the possible risks, complications, and side effects of the proposed Treatment;
• I have been advised of and understand the reasonable alternatives to the proposed Treatment (and related care/procedure(s)/treatment, including the risks and benefits of foregoing treatment altogether);
• I have been advised of and understand the possible benefits of the proposed Treatment;
• I have had the opportunity to think about my health status and condition, as well as educate myself about my health status/condition, and the proposed Treatment, and I have had an opportunity to review this Informed Consent;
• I have had the opportunity to ask any questions that I have about my healthstatus/condition and the proposed Treatment (and answers have been provided to my satisfaction in terms that I understand);
• I agree to immediately report to my practitioner’s office any adverse reactions or problems after the Treatment;
• I have not been promised or guaranteed any specific benefits from the course of Treatment; and
• I have informed my provider of any known allergies to medications or other substancesand of all current medications and supplements I currently take.
• Based on the foregoing, I knowingly and voluntarily consent to proceed with the proposed Treatment and related (and future) care/procedure(s). I also consent to the performance of any additional procedures, or to comply with treatment recommendations made by my provider, determined in the course of the Treatment to be in my best interests and where delay might impair or adversely affect my health. I request and consent to weekly dosing of Semaglutide with or without B12 and/or BPC-157 and will comply with strict dietary restrictions from my provider for the purpose of losing weight. I understand that as part of the program I will be given an orientation to the program, and I will be instructed on how to administer the injections myself or make arrangements to have someone do so. I agree to immediately report any complications or adverse changes in my health duringtreatment to H2O2U Mobile IV Hydration Services LLC.