I understand that:
Each patient responds differently to medicine and may respond differently from one treatment to the next. As with all medicines, results are temporary and regular dosing is necessary. The length of time the injectable medication lasts varies in each patient. NO guarantee can be made with regard to the results and length of time it lasts.
There are some risks with any treatment. The following is the list of possible risk with injections:
Pain or bruising, redness, bleeding at the injection site (these are usually minimal and dissipate in minimal amount of time).
Some people may experience allergic reaction to the injections.
Stomach upset and urinary problems (urge incontinence), diarrhea.
It has been reported that B12 can cause peripheral vascular thrombosis, itching.
B12 is contraindicated in Leber’s hereditary optic neuritis, as it can cause blindness.
Some patients have reported experiencing joint pain.
Weight loss can be inconsistent from one week to the next.
I had been given the opportunity to have all of my questions answered.
I will inform my practitioner of any changes in my medical history, current medications, and/or any changes relevant to this procedure prior any further treatments.
I have read and understand the ingredients of the injections being administered to me and I consent to treatment. I further acknowledge that I am taking this injection(s) of my own accord. I agree to release the facility and the medical
practitioner from any liability arising from the procedure.