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Purpose and Nature of Peptide Therapy: I understand that Down-to-Earth Wellness Center offers peptide therapy as part of an integrative wellness and medical program. Peptides are short chains of amino acids that can influence various biological functions and support healing, regeneration, hormone balance, metabolism, and inflammation control. Therapies may include, but are not limited to, Semaglutide, Tirzepatide, BPC-157, KPV/BPC-157 combination, Tesamorelin, and CJC-1295/Ipamorelin. These peptides may be used for weight loss, gut repair, inflammation reduction, tissue healing, immune support, or hormonal optimization under provider supervision.
Benefits of Peptide Therapy: Potential benefits of peptide therapy include enhanced fat metabolism, improved body composition, reduced inflammation, better sleep, increased energy, faster recovery from injuries, enhanced immune response, gut lining repair, and improved hormone regulation. Effectiveness varies based on the individual and specific peptide prescribed.
Risks and Side Effects: While generally well tolerated, I understand that peptide therapy can involve risks and side effects. These may include injection site reactions such as pain, redness, or swelling, as well as nausea, fatigue, appetite changes, headache, dizziness, or allergic reaction. Some peptides may cause hormonal changes, fluid retention, or mild gastrointestinal upset. Rare but serious risks may include elevated blood sugar, liver enzyme changes, or unforeseen interactions with medications or health conditions. All injections and usage instructions will be provided by trained staff under medical direction.
Medical Disclosure: I have disclosed all medical conditions, allergies, current medications, and supplements to the provider. I understand that this information is critical to ensure the safety and appropriateness of peptide therapy. I agree to follow all instructions, report any adverse effects immediately, and complete any recommended lab testing to monitor progress and safety.
Alternative Options: I understand that alternatives to peptide therapy include lifestyle modification, traditional medications, dietary changes, or no treatment at all. I am electing to proceed with peptide therapy as part of a wellness program offered at Down-to-Earth Wellness Center.
Consent and Release of Liability: By signing the Consent & Authorization Summary Signature Page, I acknowledge that I have read and understand the information in this consent form. I have had the opportunity to ask questions and receive satisfactory answers. I voluntarily consent to receive peptide therapy at Down-to-Earth Wellness Center. I understand that this therapy is considered off-label in many cases and is not guaranteed to provide specific results. I release and hold harmless Down-to-Earth Wellness Center, its staff, and affiliates from any claims or liability related to my participation in this therapy, except in cases of gross negligence or malpractice.