Vitamin B-12 helps maintain good health and has been shown to be beneficial in helping to: Reduce stress, fatigue, improve memory and cardiovascular health, and maintain a 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.
Facts about Vitamin B12:
· As we age we absorb less Vitamin B12 from our food
· Food sources include fish, meat, eggs, dairy
· Essential nutrient that your body can’t make on its own
· Many people who have autoimmune disorders, chronic inflammation and gastric disorders are unable to absorb Vitamin B12 from food or oral supplements
B12 Injections are better absorbed by the body since they go directly into the blood stream. Alternatives to B12 injections are Oral Vitamins, B12 Patch, Lozenges, Liquid drops and Nasal Spray
B12 Injections common side effects include but are not limited to:
1. 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
2. If any of these side effects become severe or troublesome I will contact my physician immediately
3. I understand that although rare Vitamin B12 injections can result in serious side effects. Although this is a relatively rare occurrence, anyone taking vitamin B12 injections should be aware of the possibility.
a. Uncommon side effects are much more serious than the common side effects of B12 injections, and such side effects should be reported to a physician to be evaluated for seriousness. These include • rapid heartbeat • chest pain • flushed face • muscle cramps and weakness • difficulty breathing and swallowing • dizziness • confusion • rapid weight gain • tight feelings in the chest • hives, skin rashes • shortness of breath when there is no physical exertion and unusual wheezing and coughing.
4. Please let us know if you are pregnant, lactating or have any of the following conditions.
a. Leber’s Disease • Kidney disease • Liver disease • An infection • Iron deficiency • Folic acid deficiency • Receiving any treatment that has an effect on bone marrow • Taking any medication that has an effect on bone marrow • An allergy to cobalt or any other medication, vitamin, dye, food or preservative
5. I understand that certain herbal products, vitamins, minerals, nutritional supplements, prescription and non-prescription medications may result in side effects when they interact with the B12 Injection.
By signing below, I acknowledge that I have read the foregoing informed consent and agree to the treatment with its associated risks. I hereby give consent to perform this injection. I hereby release the nurse practitioner, the person injecting the B12 and the facility from liability associated with this procedure.
Form is valid for 1 year from completion date