SEMAGLUTIDE INJECTIONS INFORMED CONSENT
I give my consent to taking Semaglutide Injections as prescribed by my healthcare provider. Semaglutide is a human-based glucagon-like peptide-1 receptor agonist used to manage chronic weight and diabetes. I have been informed of the correct method of administering semaglutide injections and the dosage. I will not take this medication if I have a history of the following:
* Pregnant or planning to conceive while using this medication
* Personal or family history of Medullary Thyroid Carcinoma (Thyroid Cancer)
* Multiple Endocrine Neoplasia Syndrome Type 2 (MEN2).
* History of pancreatitis, kidney failure/disease, liver failure/disease, or digestive issues.
* Allergic to Semaglutide or other GLP-1 agonist medications (e.g., Adlyxin®, Byetta®, Bydureon®,
Ozempic®, Rybelsus®, Trulicity®, Victoza®, Wegovy®), or you have other undisclosed allergies.
* Diabetic, have retinopathy or take medication to lower blood sugar without consulting your
endocrinologist.
Possible side effects: nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, dyspepsia, dizziness, abdominal distension, belching, hypoglycemia, flatulence, gastroenteritis, and gastroesophageal reflux disease. Common injection site reactions include itching, burning, and skin thickening (welting). In case of any serious allergic reaction, such as rash, itching, swelling of the face, tongue, or throat and anaphylaxis, seek immediate medical assistance.
Possible drug interactions: anti-diabetic agents, particularly Insulin and Sulfonylureas, can lead to an increased risk of hypoglycemia (low blood sugar). Additionally, do not combine with other GLP-1 agonist medicines (i.e., Adlyxin®, Byetta®, Bydureon®, Ozempic®, Rybelsus®, Trulicity®, Victoza®, Wegovy®). Inform your provider of any medications that may lower blood sugar.
I acknowledge that semaglutide is one part of a comprehensive lifestyle approach that includes a healthy diet and exercise, and regular follow-up visits to adjust dosages are necessary.
I acknowledge that I have provided complete and accurate information and understand that it will be used to assess my suitability for any treatment. I understand that it is my responsibility to inform the therapist of any changes to my medical history or skincare routine.
By signing below, I confirm that I have been fully informed of the potential risks, benefits, and complications and I voluntarily agree to taking this medication. I have had the opportunity to ask questions, and all my concerns have been addressed to my satisfaction. I release SLIMCARE SAN ANTONIO MEDICAL WEIGHT LOSS AND WELLNESS from any liability or claims arising from the treatment.