Form

I have a history of prostate cancer, involuntarily choose to undergo implantation of subcutaneous, bio, identical, testosterone, pellet therapy. I understand that such therapy is controversial and many doctors believe that testosterone replacement in my case is contraindicated. My clinician, Ashley Caldwel has informed me that there is a recommendation to abstain from testosterone replacement therapy until I've been determined to be free. Prostate cancer for a period of at least two years.

 

Although evidence supports the health benefits of testosterone, including the prevention of mini cancers, my treating clinician has informed me that the endogenous or eggs dodging this testosterone could possibly increase the proliferation of cancerous cells in an undetected cancer. Accordingly, I am aware of the prostate cancer or other cancer could develop while on pellet therapy.

 

I have assess the risk on a personal basis, and perceived value of the hormone therapy, outweighs the risk. I am, therefore, choosing to undergo testosterone pellet therapy. Despite the information I was given by my treating provider.

 

I acknowledge that I dare full responsibility for any personal injury or illness, accident, risk, or loss (including death and/or prostate issues)hey, that may be sustained by me in connection with my decision to undergo testosterone pellet therapy, including, without limitation, any cancer that could develop in the future, whether it be deemed a stimulation of current cancer or new cancer. 

 

I hear by release and agree to hold harmless 4You LLC and there are physicians, nurses, officers, owners, directors, employees, and agents from any and all liability, claims, demands and actions are rising or related in any lost property, damage, illness, injury, or accident that may be sustained by me as a result of testosterone pellet therapy.

 

I acknowledge and agree that I have been given adequate opportunity to review this document, and to ask questions. This release and hold harmless agreement is and shall be binding on myself in my heirs, assigns and personal representatives. 

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