1. NATURE OF THIS DOCUMENT. This is a legally binding informed consent for the off-label use of four compounded medications prescribed by Farzad David Mahjoubi, MD, through NutraBrain Clinic, Inc. d/b/a Dr. David Wellness (drdavidwellness.com): (a) AndroLift sublingual Testosterone/Enclomiphene; (b) NexArouse sublingual Apomorphine/Sildenafil/Oxytocin; (c) FollicaRx Advanced topical serum (Minoxidil, Ketoconazole, Latanoprost, Niacinamide, and compounded topical Finasteride); and (d) NAD+ self-injectable. Read every section before signing. If anything is unclear, stop and contact our office at (818) 570-1640 or dr@nutrabrainclinic.com before signing.
2. COMPOUNDING AND OFF-LABEL DISCLOSURE. Each product is a pharmaceutical-grade compounded medication prepared by a licensed compounding pharmacy and is NOT FDA-approved as a finished product. While several individual ingredients are FDA-approved for related uses, their use in these formulations and for vitality, sexual function, hair, energy, and mental clarity purposes is OFF-LABEL. Off-label prescribing by a licensed physician is legal but means the FDA has not evaluated these specific uses. I will not substitute or supplement my prescriptions with non-prescription versions purchased elsewhere.
3. CONTROLLED SUBSTANCE — TESTOSTERONE. I understand testosterone is a Schedule III controlled substance under federal law. I agree to use it only as prescribed, never to share, sell, or transfer it, and to store it securely away from others, children, and pets.
4. TELEHEALTH RELATIONSHIP. This is a telehealth prescribing relationship. Dr. Mahjoubi has not physically examined me and evaluates me only by questionnaire, secure messaging, telephone, or video. Telehealth depends entirely on the accuracy and completeness of the information I provide. I am responsible for accurately disclosing my full medical history, all medications and supplements, and any changes during treatment. This relationship is limited to prescribing these products and related follow-up and does not make Dr. Mahjoubi my primary care physician; I will continue routine care with my own physician.
5. TESTOSTERONE/ENCLOMIPHENE (AndroLift) — RISKS. Cardiovascular risk (heart attack, stroke, blood clots, elevated blood pressure); polycythemia requiring periodic CBC/hematocrit monitoring; suppression of natural testosterone, testicular atrophy, and impaired fertility (enclomiphene is included to help mitigate this but preservation is not guaranteed); prostate growth/worsening BPH and contraindication in known or suspected prostate or breast cancer; mood or behavioral changes; acne or hair changes; worsening sleep apnea; estrogenic effects including gynecomastia; sublingual transference risk (I will wash hands and avoid oral contact while the tablet dissolves); and enclomiphene visual disturbances (I will stop and report any vision changes). Recommended lab monitoring (testosterone, CBC/hematocrit, CMP/liver, lipids, PSA, estradiol, LH/FSH) may be required, and failure to complete it may end my prescription.
6. NEXAROUSE (Apomorphine/Sildenafil/Oxytocin) — RISKS. SILDENAFIL interacts dangerously with nitrates and guanylate cyclase stimulators (riociguat) and can cause life-threatening low blood pressure; I confirm I do not use these. Sildenafil can rarely cause sudden vision loss (NAION), sudden hearing loss, and prolonged erection (priapism over 4 hours is an emergency). APOMORPHINE can cause severe nausea/vomiting, sudden blood pressure drops with fainting, drowsiness, and rare impulse-control disorders (compulsive gambling, hypersexuality, shopping, or eating); I or my partner will watch for new urges and stop if they occur. NexArouse is intended for arousal difficulty linked to stress, anxiety, or mood, not purely vascular or structural causes, and is not recommended with heart disease, schizophrenia, or recent stroke or heart attack. I will not combine it with alcohol, opioids, or sedatives, and will not drive or operate machinery for at least 6 hours after a dose or until any dizziness resolves.
7. FOLLICARX ADVANCED (topical) — RISKS. External scalp use only; not on broken, infected, or inflamed skin. MINOXIDIL may cause scalp irritation, unwanted facial hair, dizziness, rapid heartbeat, swelling, or chest pain. LATANOPROST may cause skin/eyelash darkening and, rarely if it contacts the eye, permanent iris color change; I will avoid eye contact and wash my hands after applying. KETOCONAZOLE may cause itching, dryness, or rare allergic reaction. TOPICAL FINASTERIDE is used off-label; although topical use is intended to limit systemic absorption, measurable amounts can still enter the bloodstream and lower DHT, so oral-finasteride side effects remain possible, including decreased libido, erectile dysfunction, ejaculation problems, reduced semen volume, breast tenderness or enlargement, mood changes including depression and anxiety, and rarely suicidal thoughts. Post-marketing reports describe sexual, neurologic, and mood symptoms that occasionally persist after stopping ('post-finasteride syndrome'); resolution is not guaranteed. Finasteride can lower PSA by about 50% (I will tell any provider ordering a PSA test that I use it) and has been associated with a small increase in high-grade prostate cancer detection. PREGNANCY PRECAUTION: finasteride can cause serious birth defects in a developing male fetus; women who are or may become pregnant must not handle it or contact a wet application site. I will keep the site covered or fully washed and dry before skin contact with any pregnant person, anyone who may become pregnant, anyone breastfeeding, or anyone under 18, and will not donate blood while using it and for one month after my last dose.
8. NAD+ INJECTION — RISKS. NAD+ therapy is elective and not medically necessary. I am responsible for following the injection instructions; improper technique may cause pain, bruising, infection, or other complications. I will use sterile technique, never reuse needles, and properly dispose of sharps. Side effects include injection-site redness/bruising/soreness, nausea, flushing, headache, cramping, and rarely allergic reaction.
9. EMERGENCY ACTION PLAN. I will stop the relevant product(s) and call 911 or go to the nearest ER for: chest pain, fainting, irregular heartbeat, or sudden severe headache; an erection lasting more than 4 hours; sudden vision or hearing loss; difficulty breathing or swelling of the face, lips, tongue, or throat; severe persistent nausea or vomiting; or signs of injection-site infection. I will then notify Dr. Mahjoubi's office.
10. NO GUARANTEE OF BENEFIT. No guarantee, express or implied, has been made that I will experience any specific benefit. Individual response varies. No specific outcome has been promised.
11. FINANCIAL TERMS AND REFUND POLICY. The Men's Vitality Bundle fee is $595, covering physician evaluation, prescription, and the compounded medications with supplies. Because these are custom-compounded prescription medications, they cannot be returned or refunded once dispensed and shipped, except for damaged or incorrect orders reported within 48 hours of delivery. Submission and payment do NOT guarantee a prescription; if the physician determines I am not an appropriate candidate, my order will be canceled and refunded.
12. PRIVACY, COMMUNICATIONS, AND ADVERSE EVENTS. NutraBrain Clinic, Inc. d/b/a Dr. David Wellness operates in accordance with HIPAA; the Notice of Privacy Practices and Terms of Service are at drdavidwellness.com. I authorize communication by email, secure portal, telephone, and text and accept the inherent privacy risks of email and text; I may opt out of non-essential messages by replying STOP. I authorize transmission of my prescriptions to the compounding pharmacy. Dr. Mahjoubi may report adverse events to FDA MedWatch (www.fda.gov/medwatch, 1-800-FDA-1088) and the pharmacy as permitted by law.
13. VOLUNTARY CONSENT, RELEASE, AND GOVERNING LAW. My consent is voluntary and without coercion. I may withdraw at any time, subject to non-refundability of medication already shipped, and will not abruptly stop testosterone without medical guidance. I accept full responsibility for my decision to use these products and to self-administer the NAD+ injection, and I agree to hold Farzad David Mahjoubi, MD, and NutraBrain Clinic, Inc. d/b/a Dr. David Wellness harmless from any adverse outcome arising from my failure to disclose accurate information or follow instructions, except in cases of gross negligence or willful misconduct. This consent does not waive any of my legal rights and is governed by the laws of the State of California except where applicable law requires otherwise (e.g., state medical board complaints). I am at least 18 years old, biologically male, of sound mind, and legally competent to consent.