WildBerryMD – Informed Consent and Acknowledgment of Risk

Phentermine (Appetite Suppressant) – Telemedicine Treatment

Please read this document carefully. Your signature confirms that you understand and voluntarily agree to the information provided, including the risks, responsibilities, limitations, and terms associated with receiving Phentermine therapy via telehealth from WildBerryMD.

Eligibility

• You must be 18 years of age or older.
• You must reside in Arizona at the time of your consultation and treatment.

What Is Phentermine?

Phentermine is a prescription medication used for short-term weight loss support. It works by reducing appetite and may help increase energy. Phentermine is intended to be combined with nutrition, exercise, and lifestyle changes for best results.

Potential Side Effects

Phentermine may cause:

• Increased heart rate or blood pressure
• Insomnia or difficulty sleeping
• Dry mouth
• Restlessness or irritability
• Constipation
• Headache
• Dizziness
• Anxiety, irritability, mood swings, or (rarely) depression or psychosis in sensitive individuals
• Rare but serious risks: chest pain, shortness of breath, fainting, primary pulmonary hypertension, or heart valve disease

⚠️ Other unknown or unexpected side effects may occur and must be reported to WildBerryMD immediately.

Who Should NOT Use Phentermine

You should NOT take Phentermine if you:

• Are under 18 or over age 65
• Have a history of heart disease, uncontrolled high blood pressure, arrhythmias, heart failure, or have a pacemaker
• Have had a stroke
• Have glaucoma, hyperthyroidism, or severe anxiety
• Are pregnant, planning pregnancy, or breastfeeding
• Have a history of drug or alcohol abuse/li>
• Are currently taking antidepressants, ADHD medications, or other stimulants that could cause adverse interactions
• Are taking MAO inhibitors or have taken them within the last 14 days
• Consume energy drinks or excessive caffeine; caffeine intake must be limited while on Phentermine
• Consume alcohol, recreational drug use, or other stimulant substances, which may increase side effects and health risks
• Have uncontrolled high blood pressure or an elevated resting pulse/heart rate

⚠️ This list is not exhaustive. Other medical conditions or substances may make Phentermine unsafe for you. You must disclose your complete medical history, current medications, allergies, and lifestyle habits (including caffeine, alcohol, and drug use) to WildBerryMD before starting treatment.

Telemedicine Limitations

• Care is provided via telehealth only; no in-person examination will occur.
• WildBerryMD is not your primary care provider or specialist. You must continue routine medical care with your own physician.
• Telehealth has limitations in evaluating emergencies or complex medical conditions.

Patient Responsibilities

• Will provide accurate and complete health information to WildBerryMD.
• Will immediately report any changes in your health status, blood pressure, body weight, pulse, or medications.
• Will read the medication insert provided by the dispensing pharmacy before starting Phentermine and follow its instructions.
• Will avoid energy drinks, limit caffeine intake, and not consume alcohol, recreational drugs, or other stimulants while taking Phentermine.
• Will not use Phentermine with other medications that may cause harmful interactions.
• Understand that safe use depends on following medical guidance, reporting adverse effects, and maintaining follow-up appointments.
• Programs are not FDA-approved to diagnose, treat, cure, or prevent any disease
• Phentermine is a controlled prescription medication and may not be suitable for all patients.
• Care provided via telehealth has limitations and does not replace ongoing care by your primary care provider.
• Financial & Treatment Terms
• You agree to pick up your prescription medication at a pharmacy of your choice.
• You understand this is a self-pay service and insurance is not accepted.
• You agree to pay WildBerryMD’s consultation fee separately from any pharmacy charges.
• No refunds or exchanges will be provided once consultation services are rendered.
• You understand that results are not guaranteed and individual outcomes will vary.

Patient Responsibilities

I understand that taking Phentermine involves risks, including but not limited to the side effects and complications listed above. I acknowledge that these risks cannot be fully predicted and that individual reactions may vary.

By signing this consent, I agree to assume all responsibility for my use of Phentermine and any outcomes resulting from treatment. I agree to hold harmless, indemnify, and release WildBerryMD, its providers, and staff from any and all liability, claims, or damages that may arise from my decision to pursue this elective treatment via telehealth.

Acknowledgment & Acceptance of Risks

I understand the potential benefits and risks of Phentermine therapy. I have had the opportunity to ask questions via telehealth and all questions were answered to my satisfaction. I accept responsibility for reporting changes in my health, medications, and physical measurements, and for following medical advice.