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Medical Release

Informed Consent for Semaglutide

Your healthcare professional at BeautyDrip Medical Services, PLLC (“BeautyDrip”) has recommended that you, the undersigned patient, receive Semaglutide treatment. Please review this consent form, which contains information about Semaglutide treatment.

Nature and Character of Proposed Treatment:
Originally developed to treat diabetes, Semaglutide has been used for several years as an injectable medication to enhance glycemic control. The United States Food and Drug Administration (FDA) recently approved it as a prescription aid for weight loss.
As a glucagon-like peptide-1 (GLP-1) receptor agonist, Semaglutide can be ideal for individuals who are overweight or obese and committed to long-term, substantial weight loss, provided they do not have major underlying health issues. This long-acting medication requires several months or more of treatment.
Semaglutide is administered via subcutaneous injections and functions by prompting the pancreas to increase insulin production. This slows stomach emptying, a process that begins a chain reaction making Semaglutide effective for weight loss.
The slower emptying of the stomach prolongs feelings of fullness to the brain, even with reduced food intake. This extended sensation of satiety leads to significant appetite suppression, leveraging the body's natural insulin production.
Semaglutide injections are not recommended for individuals who only need to lose a small amount of weight or those with a body mass index (BMI) of 27 or less. They are also unsuitable for those seeking immediate or short-term weight loss solutions.
While using Semaglutide, it is highly recommended that you:
· Focus on a fiber-rich diet, emphasizing fruits and vegetables.
· Eat small meals that are high in protein, since this medication slows digestion.
· Steer clear of high-fat foods, which take longer to digest.
· Moderate your alcohol consumption, as this medication can reduce blood pressure.
· Ensure you drink at least 32 ounces of water daily to prevent constipation.
Anticipated Results of the Proposed Treatment:
Patients using Semaglutide can accomplish medically assisted weight loss without undergoing invasive surgery. Additionally, a Semaglutide regimen can lead to healthier blood sugar levels, boosting energy levels throughout the day. Stable and well-regulated blood sugar levels can enhance overall health in various ways. Even for individuals not at risk for diabetes, this benefit can improve overall well-being, a vital element in any weight loss journey.
1.Recognized Serious Possible Risks and Complications

Potential side effects of a Semaglutide regimen may include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion, dizziness, abdominal distension, belching, hypoglycemia (low blood sugar), flatulence, gastroenteritis, gastroesophageal reflux disease, pancreatitis, and vision loss. Common reactions at the injection site include itching and burning, sometimes accompanied by skin thickening (welting). If you experience any of these side effects or others not listed, stop using semaglutide and contact your healthcare professional.

Although severe allergic reactions to this drug are rare, immediate medical attention should be sought if you experience symptoms such as rash, itching, swelling (especially of the face, tongue, or throat), severe dizziness, or difficulty breathing. Report any adverse side effects to your healthcare professional or pharmacist. In emergencies, call 911 immediately.

Do not use Semaglutide if:

• You have a personal or family history of medullary thyroid carcinoma.

• You have Multiple Endocrine Neoplasia Syndrome Type 2.

• You are pregnant or planning to become pregnant while taking this medication.

• You are diabetic and/or taking medications to lower your blood sugar levels without consulting your endocrinologist.

• You are prescribed insulin; this combination may increase your risk of hypoglycemia (low blood sugar), and dosage adjustments may be necessary.

• You have a history of pancreatitis.

• You are allergic to BPC-157, Semaglutide, or other GLP-1 agonists such as Adlyxin®, Byetta®, Bydureon®, Ozempic®, Rybelsus®, Trulicity®, Victoza®, Wegovy®.

• You have other allergies. This product may contain inactive ingredients that can cause allergic reactions or other problems. Discuss any allergies with your healthcare professional, and provide a complete medical history before starting this medication.

Semaglutide may interact with several drugs, particularly anti-diabetic agents like insulin and sulfonylureas (e.g., glyburide, glipizide, glimepiride, tolbutamide), increasing the risk of hypoglycemia (i.e., low blood sugar). This is not an exhaustive list of drug interactions, so please inform your provider about all medications you are currently taking. Do not take Semaglutide with other GLP-1 agonists.(Required.)
2.Possible Alternative Forms of Treatment:

Alternative treatments for weight loss include lifestyle modifications such as changing your diet, increasing physical activity, and undergoing behavioral therapy. While these methods can offer sustainable weight loss and overall health improvements, they require significant and continuous lifestyle adjustments and pose the challenge of maintaining weight loss. Other prescription weight loss medications are available, though they may cause various side effects, including gastrointestinal issues and potential dependency.

Patient Acknowledgement and Consent:

I hereby acknowledge that I have read and understood the nature and character of the Semaglutide treatment. I have been informed of the benefits and risks associated with such treatment, as well as the alternatives to this treatment. My BeautyDrip healthcare professional has answered all my questions regarding the treatment to my satisfaction. By signing below, I voluntarily consent to receive Semaglutide treatment.(Required.)
3.Type Your Name Accept(Required.)
4.Your Date of Birth(Required.)