MediZen Revitalize – Medical Weight Loss Informed Consent
  • MediZen Revitalize – Medical Weight Loss Informed Consent

    This document outlines the risks, benefits, alternatives, and responsibilities associated with medically managed weight loss treatment. Please read carefully before signing.
  • Treatment Overview

  • Medically managed weight loss may include prescription medications such as GLP-1 receptor agonists or other FDA-approved or off-label treatments. These medications are intended to assist with appetite regulation, metabolic support, and weight reduction when combined with appropriate lifestyle modification.

    Individual response varies. No specific outcome or amount of weight loss is guaranteed.

  • Potential Benefits

  • Potential benefits may include weight reduction, improved blood sugar control, improved blood pressure, improved lipid levels, and enhanced metabolic health. These benefits depend on adherence to medication instructions, lifestyle participation, and individual physiology.

  • Potential Risks & Side Effects

  • Common side effects may include nausea, vomiting, diarrhea, constipation, abdominal discomfort, reflux, fatigue, headache, and decreased appetite. Most side effects are temporary and may improve with dose adjustment or time.

    More serious but uncommon risks may include pancreatitis, gallbladder disease, kidney injury, severe gastrointestinal complications, allergic reaction, or thyroid tumors in predisposed individuals. Individuals with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN2) are not appropriate candidates for GLP-1 receptor agonist therapy.

    Patients agree to promptly report severe abdominal pain, persistent vomiting, signs of dehydration, allergic reaction, or any concerning symptoms to their provider.

  • Alternatives to Treatment

  • Alternatives to medication-assisted weight loss include lifestyle modification alone, structured nutrition programs, behavioral therapy, bariatric surgery, or choosing not to pursue treatment. I understand that I may choose any of these alternatives or discontinue treatment at any time.

  • Patient Acknowledgment & Responsibilities

  • Voluntary Consent

  •  - -
  • Monitoring & Follow-Up

  • Ongoing monitoring, including periodic follow-up visits and laboratory testing when indicated, may be required to ensure safety and effectiveness. I understand that failure to complete recommended follow-up or laboratory testing may result in discontinuation of treatment.

  • Should be Empty: