Consent Form for Peptide and Vitamin Injections

Purpose

I understand that I am being offered peptides and/or vitamin injections as part of my treatment plan, which may not be FDA approved, and I am electing to proceed with this therapy. These injections may include, but are not limited to, B-complex vitamins, Vitamin D, Vitamin C, amino acids, and various peptides for health optimization, immune support, or other therapeutic purpose as discussed with my provider.

Procedure

• The injection(s) will be administered intramuscularly or subcutaneously, as appropriate.
• The injection(s) will be performed by a qualified healthcare professional, or, if appropriate, instruction will be provided for self-injecting.

Potential Benefits

• Improved energy and well-being
• Enhanced immune function
• Support for metabolic and cellular processes
• Other benefits as discussed with my provider

Potential Risks and Side Effects

I understand that, as with any injection, there are potential risks, including but not limited to:

• Pain, redness, or swelling at the injection site
• Ineffectiveness
• Bruising or bleeding
• Infection
• Allergic reaction
• Dizziness or fainting
• Headache

Alternatives

I understand that alternatives to peptide and vitamin injections include oral supplementation or no treatment at all.

Patient Acknowledgment

• I have had the opportunity to ask questions about the treatment, risks, benefits, and alternatives.
• All my questions have been answered to my satisfaction.
• I understand that results may vary and are not guaranteed.
• I understand that I may withdraw my consent and discontinue treatment at any
• time.

Consent

I hereby authorize Boris M Bobyr, NP , and/or his designated staff to administer peptide and/or vitamin injections as described above.