GLP-1 (Semaglutide) & GLP-1 / GIP (Tirzepatide) Consent

This document serves as confirmation of informed consent for compounded GLP-1 (Semaglutide), a prescription weight management medication.

A. Patients' Informed Consent

• I willingly request that Leanefy manage my medical condition.
• I've notified my provider about any allergies, medical conditions, medications, and relevant history.
• I am aware of the therapy options available, as well as the risks and benefits of each.
• I understand how the medication works and how it should be used.
• I understand that the raw components for our GLP-1 formulations come from FDA-approved facilities. Our clinical team in our pharmacies then creates and validates custom-compounded formulations in accordance with federal and state regulations.
• Prices could change. My fee covers professional consultation, supplies, and prescription. There are separate lab fees.
• Leanefy may change pharmacies according on availability and cost.
• Improper usage of this drug can be dangerous.
• I understand the potential negative effects, including but not limited to:
  • Common side effects: digestive difficulties, headaches, dizziness, elevated heart rate, lethargy, and skin reactions at the injection site.
  • Serious responses: thyroid tumors, kidney harm, pancreatitis, gallbladder problems, and severe allergic reactions.

B. Patient Responsibility

• In order to have continuity and have the right dosage I agree to get my prescriptions from Leanefy.
• I will provide a comprehensive and honest medical history.
• I will notify my provider of any changes in my health status.
• I will take my medicine exactly as instructed.
• I will preserve my medication appropriately and administer it myself.
• I'll schedule refill appointments ahead of time.
• I will keep my medication in refrigerator, marked and separate from youngsters & family members and not share it with anyone.
• I am committed to program and will have lifestyle modification by adding moderate exercise and leanefy's recommended diets.

C. Discontinuing Medication

Leanefy may stop my medication if:

• I am experiencing significant adverse effects.
• I am dishonest about my medical background.
• I fail to stick to the treatment plan.
• I break any of the obligations mentioned in this agreement.

I affirm that I understand the nature of telehealth consultations, the dangers associated, and my roles. I agree to receive Leanefy LLC's telehealth services. (We acknowledge the receipt of your consent form which was submitted at the time of completion of your good faith exam.)