Terms of service.
This weight loss program consists of once-weekly subcutaneous injections of semaglutide in the lower abdominal region and/or the meaty portion of the upper arm in accord with proper dietary planning that is specific to each patient.
Prior to initiating treatment, an initial Telehealth visit is required whereby the Medical Director of the practice, or other licensed medical clinician operating under the supervision of the Medical Director, will assess the patient thoroughly. The assessment includes obtaining a detailed medical history in order to determine eligibility.
During the weekly visits, the clinician will consult with the patient and recap the events of the previous week as well as discuss any progress or adverse reactions they may notice due to the use of this medication.
Dose titration is to be completed on a monthly basis; as such, every 4 weeks the patient’s assigned clinician will evaluate the patient’s progress thoroughly and review the patient’s diet/exercise plan in accordance with the patient’s response to the medication.
It is required at the licensed medical clinicians discretion that blood laboratory testing be performed at baseline (prior to initiating treatment) and after 3 or 6 months of therapy as per the patient’s clinician’s discretion. The panel should include, but is not limited to, fasting blood glucose, A1c, lipid, and thyroid levels in order to assess the effects of the medication.
Fees for blood work, consultation, and shipping are entirely separate from the cost of the medication as well as the monthly administration fee (if applicable).
By accepting these terms of service, the patient acknowledges that unforeseeable complications can occur. The patient understand the risks and benefits of the treatment and am aware that said patient has the opportunity to have all of their questions answered.
In addition, the patient fully comprehends the risks of using this medication, that said patient is clear about the expected weight loss outcomes of this program, and understands that treatment with this medication may not result in the weight loss that patient may expect to attain. Accepting the terms and conditions on this form affirms that the patient has given consent to the Semaglutide protocol as specified under the terms of service.
The medications dispensed by our healthcare professionals are intended solely for the individual patient named in the dispensing record and are not transferable to any other person. The patient shall agree not to share, sell, or otherwise transfer any dispensed medications to any other individual. Each dispensed medication is specifically tailored to address the medical needs of the named patient, taking into consideration their medical history, current health status, and other relevant factors. As the patient, you acknowledge that the dispensed medication is for your personal use only, and you are responsible for its proper storage, administration, and adherence to the dispensed and prescribed dosage and schedule. You are required to promptly inform our healthcare professionals of any changes in your health status, medical condition, or other relevant factors that may impact the appropriateness of the dispensed medication. You understand that medications dispensed by our healthcare professionals are based on their professional judgment and expertise. You agree not to seek or follow medical advice from non-professional sources regarding the patient’s dispensed medications. Violation of this section may result in termination of services. We reserve the right to take appropriate actions to protect the health and safety of all individuals involved.
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Possible common side effects include nausea, vomiting, diarrhea, heart burn, increased gas production, stomach pain and constipation. Serious side effects include low blood sugar, kidney and gallbladder disturbances, changes in vision, serious allergic reactions, and inflammation of the pancreas. Do not use semaglutide if you or your family have ever had medullary thyroid cancer, thyroid cancer, or if you have Multiple Endocrine Neoplasia Type II; if you have had problems with your pancreas of kidneys, diabetic retinopathy, or if you are pregnant/breastfeeding. Stop using semaglutide 2 months before you plan to become pregnant. Semaglutide may cause serious side effects including possible thyroid tumors, including cancer. Tell your health care provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath.
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