NAD+ Consent Form

NAD+ Nicotinamide Adenine Dinucleotide is a form of Vitamin B3 (Niacin). This coenzyme is found in the mitochondria of all living cells. This coenzyme is heavily involved in DNA repair and cellular remodeling. It has been known to “ turn off” those genes that accelerate degenerative aging and is essential for maintaining neurotransmitter levels for the proper functioning of the brain. It is key in cellular metabolism. As we age, our NAD levels decrease making us less able to repair cellular damage. We begin to lose energy, appear older and have decreased brain function. NAD+ plays a significant role in anti-aging. With NAD+ IV therapy and the NAD+ IM/SQ Shot, the molecule works rapidly to repair cells throughout the body and neurons in the brain. It serves as a catalyst in ultimate brain restoration which assists in overcoming depression, anxiety, and common mood disorders. Restoring and supplementing NAD+ in the body may improve physical appearance, health, and quality of life.

Supplementation of NAD+ can:

• increase energy levels
• enhance mood & mental clarity
• reverse the visible effects of aging
• reduce fatigue
• restore muscle function and athletic performance
• restore brain chemistry and neurotransmitter function
• prevent & correct damage to DNA
• regulate inflammation that damages DNA
• improve physical appearance, health, and quality of life
• aid in recovering from alcohol and drug addiction, reducing the likelihood of relapse. 

 

What are the side effects of NAD therapy?

Before receiving any type of injection therapy, it’s essential to understand what side effects accompany the many benefits. While safe for most patients, the most common side effects include:

• Nausea
• Brain fog
• Redness, tenderness, or swelling at the injection site
• Bruising at the injection site
• Infection at the injection site (rare)
• Phlebitis (rare)
• Headaches/Sinus Pressure
• Anxiety
• Fatigue
• Abdominal pain/cramping
• Diarrhea

What are contraindications of NAD?

• Allergy to B3 (Niacin)
• History of any form of Cancer
• Significant family history of Cancer
• Cardiovascular - Congestive Heart Failure, multi medicated Hypertension, Arrhythmias
• Pregnancy/Breastfeeding
• Renal Disease
• Liver Disease
• Gallbladder Disease

My signature below confirms that:

I am 18 years or older and am of sound legal mind to authorize and consent to the use of NAD+ Supplemental Therapy.

I have revealed all known medical conditions and medications, and I affirm that I do not have any of the conditions described as contraindications.

The procedure set forth above has been adequately explained to me by my attending medical professional.

I have received all the information and explanation I desire concerning the procedure.

This document is intended to serve as confirmation of informed consent for NAD+ Supplemental Therapy.

My signature below confirms: I HAVE READ AND FULLY UNDERSTAND THIS CONSENT FORM AND ALL MY QUESTIONS HAVE BEEN ANSWERED, I understand I should not sign this form if IV hydration/NAD+ Supplemental therapy, its possible risks, and its possible benefits have not been explained to my satisfaction. I further understand that I should not sign this form if I have unanswered questions or if I do not understand anything in the consent form. 

By signing below, I acknowledge that I have read the foregoing informed consent and agree to the treatment with its associated risks. I hereby give consent to perform this and all subsequent NAD+ Infusions and/or Injections with the above understood. I hereby release the doctor, the person injecting NAD+, and the facility from liability associated with this procedure.