Treatment Overview

Peptide and specialty injectable therapies may include, but are not limited to, CJC-1295, Sermorelin, Ipamorelin, NAD+, Vitamin B12, Glutathione, Testosterone Replacement Therapy, or other metabolic or performance-support compounds as prescribed.

Some therapies may be prescribed off-label. Off-label prescribing is a legal and common medical practice when supported by clinical judgment and evidence.

Potential Benefits

Potential benefits may include improved energy, enhanced recovery, improved body composition, metabolic support, improved mood, improved sleep, hormonal balance support, or overall wellness enhancement. Individual response varies. No specific outcome is guaranteed.

Potential Risks & Side Effects

Common side effects may include redness, swelling, bruising, or irritation at the injection site, temporary fatigue, headache, dizziness, nausea, appetite changes, or sleep disturbances.

More serious but uncommon risks may include allergic reaction, infection at the injection site, abnormal laboratory results, hormonal imbalance, fluid retention, changes in blood pressure, or unintended physiological effects.

Certain peptide therapies may carry theoretical risks related to cellular growth stimulation. Long-term safety data for some peptides may be limited.

Patients agree to report any severe or concerning symptoms immediately, including difficulty breathing, chest pain, swelling of the face or throat, severe headache, vision changes, persistent vomiting, or signs of infection.

Testosterone replacement therapy may suppress natural hormone production and may reduce fertility. I understand these potential effects and agree to discuss fertility goals or future reproductive plans with my provider prior to initiating therapy.

Regulatory & Compounded Medication Disclosure

Some peptide or specialty injectable therapies may be compounded medications prepared by licensed compounding pharmacies. Compounded medications are not reviewed or approved by the U.S. Food and Drug Administration (FDA) for safety or effectiveness in the same manner as commercially manufactured drugs.

Compounded medications are prepared pursuant to a valid prescription based on an individual patient’s medical needs. I understand that compounded products may vary slightly in formulation depending on pharmacy preparation.

I understand that once a prescription has been transmitted to a compounding pharmacy and preparation has begun, the order cannot be canceled or refunded in accordance with federal and state pharmacy regulations.

Financial Responsibility for Medications

I understand that medication costs are separate from consultation fees and are determined by the dispensing pharmacy. Medication pricing may vary and is not guaranteed until the prescription is processed. I acknowledge that once a prescription has been transmitted and preparation has begun, medication orders cannot be canceled or refunded in accordance with pharmacy regulations.

Medical Disclosure Requirement

I confirm that I have disclosed all relevant medical conditions, medication use, allergies, and prior adverse reactions. I understand that failure to provide accurate medical information may increase the risk of complications and may result in discontinuation of therapy.

Monitoring & Laboratory Requirements

Certain peptide and injectable therapies may require baseline or periodic laboratory testing to ensure safety and appropriate response to treatment. I understand that failure to complete recommended laboratory testing or follow-up appointments may result in modification or discontinuation of therapy at provider discretion.

I understand that dosage adjustments may be required based on clinical response, laboratory results, or reported side effects.

Injection Technique & Storage Responsibility

I understand that I am responsible for properly administering injectable medications according to the instructions provided by my healthcare provider. I acknowledge that improper injection technique may reduce effectiveness or increase the risk of complications.

I understand that certain medications may require refrigeration or specific storage conditions. I accept responsibility for storing medications according to provided instructions and understand that improper storage may affect medication potency or safety.

I understand that MediZen Revitalize is not responsible for loss of medication due to improper handling, storage, or administration.

Provider Authority

I understand that continuation of peptide or specialty injectable therapy is based on ongoing medical evaluation and provider discretion. Therapy may be modified or discontinued at any time if deemed medically necessary or if safety concerns arise.

I understand that submission of forms or payment does not guarantee prescription approval or continuation of therapy.

Emergency Care Disclaimer

I understand that peptide and specialty injectable therapy provided through telehealth does not replace emergency medical care. If I experience severe or life-threatening symptoms, I agree to seek immediate emergency medical attention.