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  • INTRAMUSCULAR INJECTION CONSENT

    Vitamin B12
  • Vitamin B12 Injection Information:
    You are receiving an intramuscular injection of Vitamin B12 (Methylcobalamin), 5,000 mcg (0.2 mL). This form of B12 is a water-soluble vitamin essential for energy production, red blood cell formation, nerve function, and DNA synthesis.


    Benefits of Vitamin B12 Injections:
    Increased energy and reduced fatigue
    Improved mood and mental clarity
    Enhanced metabolism
    Nervous system support

    Possible Side Effects:
    While side effects are rare, you may experience:

    Mild pain or redness at the injection site
    Dizziness or headache
    Mild diarrhea or nausea
    Rare allergic reaction (rash, itching, swelling)

    Contraindications:
    Please consult with the provider if you have any of the following:

    Allergy to cobalt or vitamin B12
    Leber’s disease (hereditary optic nerve atrophy)
    Kidney disease or certain blood disorders
    Pregnancy or breastfeeding (please disclose)

    Client Acknowledgement & Consent:
    By signing below, I acknowledge and understand the following:

    I have been informed of the purpose, potential benefits, and possible risks of receiving a Vitamin B12 injection.
    I have had the opportunity to ask questions and all my questions were answered to my satisfaction.
    I understand that this service is not a substitute for medical care and that I should consult my healthcare provider for any medical concerns.
    I confirm that I have disclosed all relevant medical history and medications.
    I voluntarily consent to receive this injection administered by a qualified professional.

     

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