1. PURPOSE I understand that I am voluntarily electing to receive peptide-based therapy within a wellness, recovery, performance, metabolic, body-composition, or general health optimization program. These compounds may be discussed for potential support of recovery, tissue wellness, sleep, body composition, metabolic goals, performance, or overall well-being. This consent applies to, but is not limited to: BPC-157, TB-500 / TB4 fragments, CJC-1295, Ipamorelin, AOD-9604, Tesamorelin, MOTS-C, GHK-Cu, and other similar peptide compounds or peptide blends.
2. RESEARCH / INVESTIGATIONAL USE ACKNOWLEDGMENTI understand that many peptide compounds used in wellness settings may be designated, labeled, discussed, or sourced as research-use materials, investigational compounds, or laboratory-use substances. I acknowledge that these compounds are not represented as FDA-approved medications for the diagnosis, treatment, cure, mitigation, or prevention of any disease or medical condition unless specifically stated otherwise by the provider. I understand that any discussion regarding possible effects is educational and informational only and may be based on limited human studies, preclinical data, anecdotal reports, emerging literature, or theoretical mechanisms. I understand that the clinic, providers, and staff make no warranty, representation, or guarantee regarding safety, effectiveness, clinical outcome, or therapeutic success. I voluntarily choose to proceed despite the limited evidence base, uncertain long-term safety profile, and investigational nature of these compounds.
3. FDA STATUS / OFF-LABEL / NON-APPROVED USE Many peptide therapies are not FDA-approved for the purposes for which they may be used in wellness programs. I accept that this therapy is experimental, investigational, and/or off-label innature.
4. RISKS & POSSIBLE SIDE EFFECTS Potential risks include injection-site reactions, headache, nausea, dizziness, fatigue, sleep disturbance, GI upset, appetite changes, swelling, blood sugar changes, hormonal changes, allergic reactions, contamination risk, and unknown long-term effects.
5. NO GUARANTEE OF BENEFIT No specific result is guaranteed, promised, implied, or warranted.
6. ALTERNATIVES Alternatives include no treatment, lifestyle modification, exercise, nutrition changes, sleep optimization, therapy, medications, specialist referral, or other interventions.
7. MEDICAL DISCLOSUREI confirm that I have disclosed all relevant medical history, medications, supplements, allergies, cancer history, autoimmune disease, pregnancy intentions, and prior reactions.
8. PREGNANCY / BREASTFEEDINGI attest that I am not currently pregnant or breastfeeding.
9. STORAGE / HANDLING / ADMINISTRATIONI agree to follow all storage and administration instructions and understand risks of contamination, degradation, and dosing error.
10. NO MEDICAL OR THERAPEUTIC CLAIMS These compounds are not being promoted, dispensed, or discussed with any claim that they will diagnose, treat, cure, mitigate, or prevent disease.
11. FOLLOW-UP / LABS / REPORTINGI agree to follow dosing, follow-up, and laboratory monitoring recommendations and promptly notify the clinic of side effects or changes.
12. FINANCIAL RESPONSIBILITY This therapy is cash-pay only and all payments are non-refundable once dispensed, reconstituted, or administered.
13. ASSUMPTION OF RISK / RELEASE OF LIABILITYI voluntarily assume all known and unknown risks and release the clinic, providers, staff, and affiliates from liability to the fullest extent permitted by law.
14. RIGHT TO REFUSE OR DISCONTINUE The clinic may refuse, pause, adjust, or discontinue therapy at any time based on safety concerns or clinical judgment.