Weight Loss Management Consent
Please read the following information FULLY AND CAREFULLY:
Why Semaglutide/Tirzepatide Injections?
The main benefits may include:
- Semaglutide/tirzepatide is 94% similiar to natural human GLP-1 and therefore acts as a physiological regulator of appetite and thereby reducing food intake by reducing feelings of hunger and increasing feelings of fullness/satiety.
- Semaglutide is indicated for the treatment of type-2 diabetes and weight loss managment.
- For long term success the treatment needs to be combined with lifestyle changes including nutritional, exercise and behavorial habits.
- Weight loss can lead to secondary benefits by improving weight loss related health problems such as cardiovascular risks (including hypertension, blood glucose levels, high cholesterol and waist circumference) and physical health related quality of life.
I understand that I have the right to be informed of any feasible alternative options, and the risks and benefits.
Since every human being is unique, we cannot guarantee any specific result from Semaglutide treatment. Medication and or medical conditions and lifestyle may have a negative impact on the outcomes.
Patients need to follow the instructions carefully and agree to notify Beauty Marx of any changes in medical history and/or adverse effects of the treatment.
HEALTH CONCERNS: If you suffer from a medical or pathological condition, you need to consult with an appropriate healthcare provider such as your General Practitioner prior to starting medication. You may be asked to provide a letter of acknowledgemnt from your health care provider. If you are taking medications of any kind or have a changes in medication you are required to alert Beauty Marx.
Note:If you have any physical or emotional reaction to semaglutide/tirzepatide treatment, discontinue use immediately, and contact your Beauty Marx to ascertain if the reaction is adverse or an indication of the natural course of the body's adjustment to the treatment.
You should not use semaglutide/tirzepatide if you have a known allergy or if you have the following:
- multiple endocrine neoplasia type 2 (tumors in your glands)
- a personal or family history of medullary thyroid carcinoma (a type of thyroid cancer)
- diabetic ketoacidosis
- uncontrolled insulin dependent diabetes
- history of pancreatitis
Inform Beauty Marx your if you've ever had:
- stomach or intestinal disorders
- pancreatitis
- kidney disease
- eye problems caused by diabetes (retinopathy)
- gallbladder disease
Semaglutide/tirzepatide side effects
Get emergency medical help if you have signs of an allergic reaction: hives, itching; dizziness, fast heartbeats; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your health care provider at once if you have:
- vision changes
- unusual mood changes, thoughts about hurting yourself
- pounding heartbeats or fluttering in your chest
- a light-headed feeling, like you might pass out
- signs of a thyroid tumor--swelling or a lump in your neck, trouble swallowing, a hoarse voice, feeling short of breath
- symptoms of pancreatitis--severe pain in your upper stomach spreading to your back, nausea with or without vomiting, fast heart rate
- gallbladder problems--upper stomach pain, fever, clay-colored stools, jaundice (yellowing of the skin or eyes)
- low blood sugar--headache, hunger, weakness, sweating, confusion, irritability, dizziness, fast heart rate, or feeling jittery
- kidney problems--swelling, urinating less, feeling tired or short of breath
- stomach flu symptoms--stomach cramps, vomiting, loss of appetite, diarrhea (may be watery or bloody).
Common Side Effects MayInclude:
- low blood sugar (in people with type 2 diabetes)
- upset stomach, heartburn, burping, gas, bloating
- nausea, vomiting, stomach pain, loss of appetite
- diarrhea, constipation
- stomach flu symptoms
- headache, dizziness, tiredness
I am aware that other unforeseeable complications could occur. I do not expect the clinic to anticipate and or explain all risk and possible complications. I rely on them to exercise judgment during the course of treatment. I understand the risks and benefits of the treatment and have had the opportunity to have all of my questions answered.
The American Society of Anesthesiologists (ASA) recommends that patients stop taking semaglutide/tirzepatide at least seven days before surgery or endoscopy. This is to reduce the risk of complications that can occur when food remains in the stomach longer during anesthesia, such as aspiration, vomiting, and pneumonia. I am aware that I must inform my physician in advance of any scheduled procedures or surgery.