Bpc – Peptide Consent

Purpose of This Consent

This document explains the potential benefits, risks, limitations, alternatives, and responsibilities associated with BPC-157 peptide therapy. Please read this document carefully. Ask your healthcare provider any questions before signing.

Your participation is voluntary, and you may decline or discontinue treatment at any time.

What Is BPC-157?

BPC-157 (Body Protection Compound-157) is a synthetic peptide composed of 15 amino acids. It is based on a peptide sequence identified in gastric proteins and has been studied primarily in laboratory and animal research.

Interest in BPC-157 centers on its potential role in supporting tissue repair and recovery, including tendon, ligament, muscle, gastrointestinal, and connective tissue healing. However, robust human clinical evidence remains limited.

BPC-157 has not been approved by the U.S. Food and Drug Administration (FDA) for the diagnosis, treatment, cure, or prevention of any disease.

When prescribed by your provider, it is being used as an off-label, investigational therapy based on individualized clinical judgment.

Potential Benefits

Although outcomes cannot be guaranteed, some patients may experience:

• Improved recovery following musculoskeletal injury
• Support for tendon and ligament healing
• Reduced joint discomfort
• Enhanced muscle recovery
• Improved mobility and function
• Support for gastrointestinal mucosal healing
• Improved recovery after exercise
• Improved quality of life

Clinical response varies significantly among individuals.

FDA Regulatory Status

I understand that:

• BPC-157 is not FDA-approved for any medical indication.
• The FDA has not established its safety or effectiveness for routine clinical use.
• Recommendations are based on available scientific literature, clinical experience, and individualized medical assessment.
• Long-term human safety data remain limited.

Potential Risks and Side Effects

Known or reported side effects may include:

• Injection-site pain
• Bruising
• Redness
• Swelling
• Mild bleeding
• Temporary itching
• Headache
• Nausea
• Fatigue
• Lightheadedness
• Dizziness

Less common risks include:

• Allergic reactions
• Infection
• Skin irritation
• Local inflammation
• Scarring

Unknown risks may exist because long-term human studies are limited.

Unknown Risks

I understand that:

• Human clinical research remains limited.
• Long-term effects have not been fully established.
• Unexpected side effects could occur.
• New scientific information may become available in the future.

Contraindications

Treatment may not be appropriate for individuals with:

• Pregnancy
• Breastfeeding
• Active malignancy unless specifically cleared by the treating oncology team
• Known allergy to peptide ingredients
• Serious uncontrolled medical illness
• Active systemic infection
• Significant liver or kidney dysfunction
• Uncontrolled autoimmune disease
• Bleeding disorders unless medically cleared

Additional medical conditions may require modification or discontinuation of therapy.

Drug Interactions

Patients should notify their provider if taking:

• Prescription medications
• Anticoagulants
• Corticosteroids
• Immunosuppressive medications
• Chemotherapy
• Biologic medications
• Hormone therapies
• Over-the-counter supplements

Unknown interactions may exist.

Compounded Medication Disclosure

If prescribed through a licensed compounding pharmacy, I understand that:

• The medication is individually compounded pursuant to a valid prescription.
• Compounded medications are not individually reviewed or approved by the FDA.
• The pharmacy is responsible for preparing the medication in accordance with applicable federal and state regulations.
• Potency, stability, and beyond-use dating are established by the compounding pharmacy.

Self-Injection Consent

If self-administering injections, I understand that I have received instruction regarding:

• Proper injection technique
• Needle safety
• Hand hygiene
• Site rotation
• Sharps disposal
• Safe medication storage
• Recognition of adverse reactions

I agree to contact my provider immediately if significant side effects occur.

Storage Instructions

Unless otherwise instructed by the dispensing pharmacy:

• Refrigerate after reconstitution.
• Do not freeze.
• Protect from direct sunlight.
• Keep away from children and pets.
• Use only within the pharmacy’s beyond-use date.
• Discard unused medication as instructed.

Monitoring

I understand that ongoing monitoring may include:

• Periodic medical evaluations
• Laboratory testing when appropriate
• Review of symptoms
• Medication adjustments
• Assessment of treatment response

My provider may discontinue therapy if the risks outweigh the potential benefits.

Alternatives

Alternatives include:

• Observation without treatment
• Physical therapy
• Exercise rehabilitation
• Conventional medical treatment
• Pain management
• Regenerative therapies
• Lifestyle modification
• Nutritional optimization

No Guarantee of Results

I understand that:

• Individual responses vary.
• No guarantees have been made regarding improvement.
• Treatment may not produce the desired outcome.

Financial Consent

I understand that:

• BPC – 157 injections are provided as a self-pay wellness service.
• Payment is required before my prescription is processed or dispensed.
• Due to the customized nature of compounded medications and applicable pharmacy regulations, all sales are final.
• Once my prescription has been submitted to the compounding pharmacy, BPC -157 injections are non-refundable, non-returnable, and non-exchangeable.

Patient Responsibilities

I agree to:

• Follow the prescribed dosing schedule.
• Attend recommended follow-up appointments.
• Report side effects promptly.
• Notify my provider of new medications or medical conditions.
• Follow storage and handling instructions.
• Don’t share medication with any other person.
• Continue recommended lifestyle interventions.

Right to Withdraw

I understand that I may discontinue treatment at any time after discussing my decision with my healthcare provider.

Patient Acknowledgment

By signing below, I acknowledge that:

• I have read and understand this consent form.
• I have had the opportunity to ask questions.
• My questions have been answered satisfactorily.
• I understand the investigational nature of BPC-157 therapy.
• I understand the potential benefits, risks, alternatives, and unknowns.
• I voluntarily consent to treatment.

I acknowledge that BPC-157 peptide therapy is an investigational, off-label treatment that is not approved by the U.S. Food and Drug Administration (FDA) for the diagnosis, treatment, cure, or prevention of any disease. I understand that human clinical data regarding its safety and effectiveness remain limited and that there may be risks, side effects, or complications that are currently unknown or unforeseeable.

After having the opportunity to ask questions and receive satisfactory answers, I voluntarily elect to proceed with BPC-157 peptide therapy and knowingly accept the inherent and reasonably foreseeable risks associated with this treatment.

To the fullest extent permitted by applicable law, I agree to release and hold harmless WildberryMD, its physicians, nurse practitioners, physician assistants, nurses, employees, contractors, medical directors, affiliated providers, and agents from claims, demands, damages, or liabilities arising solely from the known or unknown risks inherent to this elective, investigational therapy, provided that the care rendered complies with the applicable standard of medical care.

This provision does not waive or release any rights or claims arising from gross negligence, reckless misconduct, willful misconduct, fraud, or any conduct for which liability cannot legally be waived under applicable federal or state law.

I further agree to:

• Follow all treatment instructions and dosing recommendations.
• Promptly report any adverse reactions or unexpected symptoms.
• Attend recommended follow-up appointments.
• Inform my healthcare provider of any new medical conditions, medications, pregnancy, or planned surgical procedures during treatment.
• No, sharing or transferring my prescribed medication to any other individual.

I acknowledge that no guarantee or warranty has been made regarding the success of treatment or the achievement of any particular medical outcome. I understand that individual responses vary and that improvement cannot be promised.