must follow the program as directed in order to achieve weight loss. By consenting to treatment, I agree to pay, in full, for all visits and charges incurred at each visit.

I, the undersigned, hereby give my consent to receive treatment with semaglutide, a medication prescribed for the management of type 2 diabetes and/or chronic weight management in adults with obesity or overweight. 1. Purpose and Benefits of Semaglutide Treatment.

When used in conjunction with diet and exercise, it can cause significant weight loss. certify that I have read and understand the contents of this form. I have informed my provider of all medications and supplements I am currently taking.

Semaglutide Consent Form: This document is intended to serve as a confirmation of informed consent for compounded Semaglutide, which is a prescription weight management medication. A) Patient Informed Consent . 1. I voluntarily request that Danica Wheeler, APRN (provider) treat my medical condition. 2.

Weight Management (semaglutide) Prescription Drug Management Consent This document is intended to serve as a confirmation of informed consent for compounded semaglutide, which is a prescription weight management medication. A. Patient Informed Consent 1. I voluntarily request that Live Hearty treats my medical condition. 2.

Semaglutide and Tirzepatide are human-based glucagon-like peptide-1 receptor agonist prescribed as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) that is considered outside a …

The purpose of this form is to obtain informed consent from patients seeking treatment with Semaglutide for weight management. It outlines critical guidelines, potential risks, and necessary health disclosures required before starting this medication.

perform semaglutide subcutaneous injection on me. Semaglutide is FDA approved overweight and obese individuals struggling to lose weight. I understand that this procedure is effective at reducing appetite and energy intake while delaying gastric emptying. Semaglutide is a Glucagon-like peptide-1 (GLP-1) produced by the gut.

This document is intended to serve as a confirmation of informed consent for compounded semaglutide, which is a prescription weight management medication. I voluntarily request that …

Semaglutide is a human-based glucagon-like peptide-1 receptor agonist prescribed as an adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index ( MI) that is considered outside a healthy range.