Vitamin injections Consent

Vitamin B12 injections maintain good health and have been shown to be beneficial in helping to: Reduce stress, fatigue, improve memory and cardiovascular health, and maintain a good body weight. It can also assist the body in converting proteins, fats and carbohydrates into energy and is necessary for healthy skin and eyes.

MIC+B12 Sometimes diet and exercise alone won’t cut it; more often than not it is a simple fact that you lack vital nutrients and vitamins in the body. In turn, you can’t shed those excess pounds you’ve been trying to get rid of for so long. To burn fat and build muscle, you need to replenish those essential vitamins and minerals.

MIC+B12 Ingredients

Methionine – The essential amino acid works as a deactivating agent. Estrogen and sulfur-containing hormones are kept at bay, and it helps defend harmful compounds in our system.

Inositol – The lipotropic is in the Vitamin B family. It works many biological processes, helps break down fat, and can be used in treating PCOS effectively. Other female dysfunctions are often treated using Inositol as well.

Choline – The essential nutrient is vital for liver functionality, and it helps transport bile and stored fat. Exported fat burns, detoxes the liver, and helps promote healthier weight loss results.

Vitamin B12 (cyanocobalamin) – Normal blood flow, brain functionality, heart and nervous system functions, are all served by the essential vitamin. It also helps fat metabolize, meaning you are going to lose weight more easily.

• Increased energy
• Boost metabolism
• Improve liver detoxification
• Weight loss
• Sleep regulation
• Promotes neurological activity
• Supporting healthy cell growth and repair
• Maintaining normal immune functions

Vitamin injections are better absorbed by the body since they go directly into the blood stream.

Risks: I understand there is a risk of mild diarrhea, upset stomach, nausea, a feeling of pain and a warm sensation at the site of the injection, a feeling, or a sense, of being swollen over the entire body, headache and joint pain.

If any of these side effects become severe or troublesome, I will contact my physician immediately.

I understand that although rare, vitamin injections can result in serious side effects. Although this is relatively rare occurrence, anyone taking vitamin injections should be aware of the possibility.

Uncommon side effects include:

• rapid heartbeat
• flushed face
• difficulty breathing and swallowing
• confusion
• hives, skin rashes • shortness of breath when there is no physical exertion and unusual wheezing, and coughing.
• chest pain
• muscle cramps and weakness
• dizziness
• tight feelings in the chest

Before starting Vitamin injections, I will make sure to tell my Physician if I am pregnant, lactating, or have any of the following conditions

• Leber’s disease
• Liver disease
• Iron deficiency
• Kidney disease
• An infection
• Folic acid deficiency
• Receiving or taking any treatment that has an effect on bone marrow
• An allergy to cobalt or any other medication, vitamin, dye, food or preservative.

I understand that I will be receiving a B12 vitamin injection or a Vitamin and Amino Acid injection consisting of Vitamin B12, methionine, inosital, and choline. This injection is commonly referred to as a lipotropic injection or a MIC-B12 “fat burner” injection.

Safe Disposal of Sharps (Arizona Guidelines)

In Arizona, home-generated sharps may be disposed of in the regular household trash if the following safety procedures are followed:

• Place all used needles, syringes, and sharps in a puncture-resistant, sealable container (e.g., an FDA-cleared sharps container or a heavy-duty plastic container such as a laundry detergent bottle).
• Seal the container lid securely and reinforce it with strong tape.
• Clearly label the container with “Not Recyclable” or “Sharps” as recommended by ADEQ guidelines.
• Do not place sharps in recycling. Dispose of the sealed, labeled container in the regular household trash.
• Never dispose of loose needles or syringes directly into household garbage.

For additional information, please refer to: Safe Needle Disposal – Arizona Guidelines (https://safeneedledisposal.org/states/arizona/)

Voluntary Participation and Telehealth Acknowledgment

By choosing to receive semaglutide therapy through WildBerryMD’s telehealth platform, I understand and agree to the following:

• I may pause, discontinue, or adjust treatment at any time. However, I understand that abruptly stopping semaglutide may result in a return of hunger, cravings, or weight regain. I agree to consult with WildBerryMD before making any changes to my treatment plan.
• I agree to notify WildBerryMD immediately if I experience side effects or feel unwell, and I will stop using the medication until further medical guidance is provided.
• I understand that WildBerryMD is a wellness-focused telemedicine provider and does not provide emergency medical care or primary care services. I agree to maintain care with my primary care provider and appropriate specialists for routine, preventative, urgent, or chronic medical needs, including lab work and medication clearance as needed.
• In the event of a medical emergency, I will call 911 or go to the nearest emergency facility. I will not rely on WildBerryMD for urgent care.
• I am responsible for:

• Providing accurate and complete health information, including any changes in medications, diagnoses, weight, blood pressure, or lab results.
• Informing my other healthcare providers (e.g., PCP, surgeons, specialists) about my participation in this program and any medications or therapies I am receiving through WildBerryMD.
• Complying with the treatment plan and lifestyle changes recommended for optimal outcomes.

Patient Acknowledgment and Consent

By signing below:

• I confirm that I have read, understood, and voluntarily agreed to all of the above terms, risks, and responsibilities related to compounded semaglutide treatment via telehealth.
• I acknowledge that I have read, understood, and agree to the inherent risks, limitations, and terms described in the WildBerryMD Telehealth Informed Consent, which governs the delivery of all telemedicine services provided by WildBerryMD.
• I understand this consent applies specifically to telehealth services provided by WildBerryMD.
• I acknowledge that I have had the opportunity to ask questions and receive answers to my satisfaction.
• I consent to initiate and continue compounded vitamin therapy through WildBerryMD as an elective, self-pay wellness service.
• I understand that results are not guaranteed and may vary depending on adherence, health status, and response to treatment.
• I agree that my electronic signature is the legal equivalent of my handwritten signature.

Results may vary and outcomes are not guaranteed. These injections are Not intended to diagnose, treat, cure or mitigate any disease. These statements have not been evaluated by the FDA. Compounded drug products are not approved or evaluated for safety, effectiveness, or quality by the FDA. Please always stop using injections if you have any side effects and call our office. You are responsible for informing WildBerryMD about any changes in your health history or medications