Peptide/Vitamin/Nutraceutical/Off-Label Medication Consent Form
I hereby request and consent to examination and subcutaneous and or intramuscular injection of vitamins and peptides as well as treatment with naturopathic care, including various modes of elective vitamins,alternative medicine, and peptide injection therapy. I understand that I am in full control of my body during the examination and it is my responsibility to inform the healthcare provider of any procedure or treatment that I may not feel comfortable with. I understand that alternative medicine and therapies used have not been FDA approved. I understand that the use of peptides in medicine is new and not mainstream medicine. Peptides and Alternative therapies have not all been proven with studies due to the major advancement in medicine. I, as a patient, have a right to be informed about my condition and recommended care. This disclosure is to help me become better informed so I may make the decision to give or withhold my consent to any proposed treatment. I understand that treatment may involve bio-identical hormones replacement, subcutaneous and or intramuscular injection of vitamins minerals and peptides etc.), collecting specimens for laboratory evaluation,including blood draws and/or ordering diagnostic imaging and tests,prescription of certain medications and nutritional supplements, counseling and dietary therapy, homeopathic medicines referred to as “remedies.” I understand the U.S. Food and Drug Administration has not evaluated or approved nutritional, herbal and homeopathic supplements; however, they have been widely used in Europe and the United States for many years. I also understand that, as with drugs, nutritional supplements, vitamin injection,bio-identical hormone replacement, herbal and homeopathic remedies may cause some side effects in certain individuals, may interact with certain allopathic medications or lab tests, or show symptoms due to certain pre-existing conditions. I do not expect the provider to be able to anticipate and explain all risks and complications, and I wish to rely on the practitioner to exercise judgment in recommending treatments that the practitioner feels at the time,based on the facts then known, are in my best interest. Nutraceuticals: Can be vitamin injections, amino acids, or combination therapies. Widely used in alternative medicine. Off-Label Use of FDA-Approved Drugs I also understand that hormone replacement, vitamin and amino acid injections and peptide therapy may include the “off-label” use of FDA-approved drugs.“Off-label use” means an FDA-approved drug is used in therapies and treatments for which the drug was not specifically approved. As much as forty-six per cent(46%) of certain classes of prescriptions are for off-label use of FDA-approved drugs. In addition, I assume full liability for any adverse effect that may result from the non-negligent prescribing of the Peptides, Nutraceuticals,Antioxidants, Hormones, Drugs, or other treatments involved in the therapies and medical care prescribed or recommended by Padgett Medical Center’s Provider and Padgett Medical Center, LLC and I waive release the practice from any and all claims (legal or otherwise), grievances, or damages (monetary or otherwise) arising from my treatment as a patient. Alternative Medicine: Alternative medicine is a term that describes medical treatments that are used instead of traditional (mainstream) therapies.Some people also refer to it as “integrative,” or “complementary” medicine.More than half of adults in the United States say they use some form of alternative medicine. Example: Using High Dose Vitamin C IV for Cancer instead of Chemotherapy. Peptides: A molecule consisting of 2 or more amino acids. Peptides are smaller than proteins, which are also chains of amino acids. Molecules small enough to be synthesized from the constituent amino acids are, by convention, called peptides rather than proteins. I agree to the use of alternative medicine, peptides, vitamin injections, and nutraceuticals. I understand that Padgett Medical Center may prescribe alternative treatments including the above and possibly the use of off-label medications for wellness, treatment of hormonal conditions, and other medical conditions. I have the right to refuse treatment and notify Padgett Medical Center, LLC if I no longer wish to continue treatment. In the event of an adverse reaction, I will go to the nearest emergency room. I am aware that Padgett Medical Center, LLC is unable to provide emergency services.