Semaglutide Treatment Consent Form
This consent form provides important information about the use of Semaglutide as part of your weight loss treatment plan at Instant Vitality Lounge, LLC. Please carefully review the following details and feel free to ask any questions you may have before providing your consent.
Semaglutide Information:
I, the undersigned, understand that I will be receiving Semaglutide as part of the weight loss program at Instant Vitality Lounge, LLC. Semaglutide is a medication that may assist in weight loss by regulating blood sugar levels and reducing appetite.
1. Purpose of Treatment:
Semaglutide is an FDA-approved medication that can aid in the treatment of obesity. It can be used as part of a comprehensive weight loss program, which includes a reduced-calorie diet and increased physical activity.
2. Benefits and Risks:
Benefits: Semaglutide may help you achieve weight loss, better blood sugar control and improve various metabolic parameters.
Risks: Like any medication, Semaglutide carries potential risks. Common side effects include nausea, vomiting, diarrhea, and constipation. It is crucial to report any unusual symptoms to your healthcare provider promptly.
3. Treatment Plan:
Your healthcare provider at Instant Vitality Lounge, LLC has prescribed semaglutide as part of your weight loss plan.
You are required to follow the prescribed dosage and administration instructions strictly.
4. Monitoring and Follow-up:
Regular monitoring of your progress and potential side effects will be conducted by your healthcare provider.
Follow-up appointments will be scheduled to assess the effectiveness of the treatment and make any necessary adjustments.
3. Responsibilities:
It is your responsibility to inform your healthcare provider of any changes in your health, including new medications or medical conditions.
Attend all scheduled appointments and promptly report any concerns related to your treatment.
6. Confidentiality:
Your personal health information will be kept confidential and in accordance with applicable laws and regulations.
7. Contact Information:
In case of emergencies or if you have any questions or concerns related to your treatment, please contact Instant Vitality Lounge, LLC at the provided email address or phone number.
By signing below, you acknowledge that you have read and understood the information provided in this consent form. You have had the opportunity to ask questions, and any concerns have been addressed to your satisfaction: