Peptide therapy involves the use of specific amino acid chains (peptides) intended to support various physiological functions such as metabolism, tissue repair, hormone signaling, immune support, and overall wellness. These peptides may be administered by injection, oral capsule, or other approved routes depending on the formulation. This document is intended to inform you of the potential benefits, risks, and alternatives associated with peptide therapy. Please read carefully and ask any questions before signing.
1. Purpose of Treatment
Peptide therapy may be used for goals such as improved metabolism, weight management, recovery, skin rejuvenation, energy, sleep quality, immune support, or hormone optimization. Results vary between individuals and no specific outcomes are guaranteed.
2. Potential Benefits
Potential benefits may include improved recovery, improved metabolic function, increased energy, improved body composition, skin health, and general wellness. Benefits are not guaranteed and may vary by individual.
3. Possible Risks and Side Effects
Potential side effects may include but are not limited to injection site reactions (redness, swelling, pain, bruising), headache, nausea, fatigue, dizziness, fluid retention, allergic reaction, changes in appetite, or unknown side effects. Because some peptide therapies are relatively new, long-term risks may not be fully known.
4. Alternatives
Alternatives may include lifestyle modification, diet and exercise changes, conventional medications, hormone therapy, or no treatment at all.
5. Off-Label Use
Some peptide therapies may be considered off-label or part of wellness optimization practices and may not be FDA-approved for the specific indication being treated.
6. Patient Responsibilities
You agree to provide a complete medical history, disclose all medications and supplements, follow dosing instructions, attend recommended follow-ups, and report any side effects promptly.
7. Voluntary Participation
You understand that peptide therapy is voluntary and you may stop treatment at any time. Choosing not to participate will not affect your ability to receive other services.
8. Decision Making
I am a legal adult 18 years of age or older and I am fully competent to make my own health care decisions. I am fully aware of potential side effects and/or problems associated with this medication and understand that it is a violation of the law to falsify any information on my medical questionnaire or other medical records for the purpose of obtaining prescription medication.
Consent
The information I give the provider and nursing staff is accurate and complete to the best of my knowledge. Any changes to my medical history will be communicated to a TOP BEAUTY BAR provider immediately.
By signing below, I acknowledge that: I have read, acknowledge and understand the information provided above.
- I have had the opportunity to ask questions and have received satisfactory answers.
- I understand the potential risks and benefits.
- I voluntarily consent to receive peptide therapy.
- I agree that before starting peptide therapy, labs from the past 6 months will be provided or scheduled through Top Beauty Bar.