Peptide Therapy Consent and Acknowledgment
Please read and understand each statement carefully:
- Overview: Peptides are amino acids with biological activity that can mimic certain hormones within the body. They have the ability to stimulate the natural production of specific hormones to achieve desired physiological effects, which will be discussed with Amber Tomse, APRN. Some peptides are FDA-approved for the treatment of specific medical conditions, while others are investigational and not FDA-approved for marketing or general human consumption. However, clinical studies have demonstrated a favorable safety profile for many of these compounds.
- Off-Label Use: The use of peptide therapy for preventative care, weight loss, performance enhancement, anti-aging, or any other condition discussed by Amber Tomse, APRN, is considered off-label use by the FDA.
- Administration Methods: Peptide therapy may be administered orally, subcutaneously, intramuscularly, intravenously, or intranasally. The appropriate method of administration will be discussed with me by Amber Tomse, APRN.
- Pharmacy and Preparation: All peptide therapies provided by Amber Tomse, APRN, D.B.A. Beauty Refined, LLC are prepared by registered compounding pharmacies that comply with all state and federal regulations.
- Liability for Manufacturing: I acknowledge that Amber Tomse, APRN, D.B.A. Beauty Refined, LLC is not responsible for any manufacturing issues related to peptides prepared by compounding pharmacies. The compounding pharmacies bear sole responsibility for sterility, potency, and safety.
- Elective Nature of Treatment: I understand that peptide therapy may not be approved for my specific medical condition and is not a medical necessity. It is considered an adjunctive and elective therapy to complement my overall treatment plan.
- Pregnancy Disclaimer (Women Only): There is limited research regarding the safety of peptide therapy in pregnant or breastfeeding women. I certify that I am not pregnant, nor do I plan to become pregnant while undergoing peptide therapy.
- Potential Side Effects: As with any medication, peptide therapies may cause side effects, including but not limited to:
rash, fever, nausea, vomiting, allergic reactions, decreased insulin sensitivity, flushing, headache, fatigue, lightheadedness, abdominal cramping, joint pain, fluid retention, or other side effects that will be reviewed during consultation with Amber Tomse, APRN / Beauty Refined, LLC.
- Alternatives to Peptide Therapy:
- Choosing no treatment
- FDA-approved standard medical treatments
- Specialist referral
- Surgical options
- No Guarantees: I understand that no guarantees are made regarding the results or efficacy of peptide therapy. My outcomes may depend on individual factors, including diet and exercise, which remain my personal responsibility.
- Communication: I agree to notify Amber Tomse, APRN, D.B.A. Beauty Refined, LLC immediately if I experience any concerns or side effects.
- Informed Consent: I certify that the risks, benefits, and alternatives of peptide therapy have been fully discussed with me, and all my questions have been answered to my satisfaction by Amber Tomse, APRN, D.B.A. Beauty Refined, LLC.
- Consent to Treatment: I hereby voluntarily consent to evaluation and treatment by Amber Tomse, APRN, D.B.A. Beauty Refined, LLC, with the goal of improving my health, performance, and supporting longevity through peptide therapy.
- Shipping and Refund Policy:
- Beauty Refined is not responsible for any lost or stolen packages.
- All sales are final. No refunds.