MOUNJARO/OZEMPIC CONSENT FORM

MOUNJARO AND OZEMPIC

 

PATIENT INFORMATION:
 
MEDICAL HISTORY

Procedure Description:

I understand that I am receiving treatment with Ozempic or Mounjaro, which are prescription medications used to support blood sugar control and medical weight management. These medications work by mimicking natural hormones in the body that help regulate appetite, slow digestion, and improve how the body uses insulin.

The medication is given by injection, as prescribed and supervised by a qualified medical provider. It helps reduce hunger, increase feelings of fullness, and support healthier eating patterns over time.

This treatment is not a quick or guaranteed weight-loss solution. Results develop gradually and depend on individual factors such as body response, lifestyle habits, diet, and activity level. Some clients may require dose adjustments or long-term use for best results.

I understand that possible side effects may include nausea, vomiting, diarrhea, constipation, reduced appetite, fatigue, or stomach discomfort, especially during the early stages of treatment. Results and side effects vary from person to person, and close medical monitoring is important throughout the treatment process.

Benefits and Risks:

I have been informed that the potential benefits of Ozempic/Mounjaro treatment may include:

• Reduced appetite and improved portion control
• Support for medical weight management
• Improved blood sugar control (for eligible clients)
• Better regulation of hunger and cravings
• Gradual and sustainable weight-related health improvements

I understand that results vary from person to person and that these medications are not a guaranteed or instant weight-loss solution. Results depend on individual response, lifestyle habits, and medical factors, and treatment may require ongoing use or adjustments.

I understand that there are potential risks and side effects associated with Ozempic/Mounjaro, including:

• Nausea, vomiting, diarrhea, or constipation
• Bloating, or indigestion
• Fatigue, dizziness, or headache
• Reduced appetite that may feel uncomfortable

Aftercare:

I agree to follow all medical and lifestyle instructions provided by the clinician, including dietary guidance, hydration, medication schedules, and follow-up visits. I understand that failure to follow aftercare and medical advice may reduce treatment effectiveness or increase the risk of side effects.

Consent for Treatment:

I hereby consent to receive Moujaro/Ozempic treatment at The Abram. I acknowledge that the clinician has explained the procedure, its purpose, potential benefits, and possible risks. I have had the opportunity to ask questions, and all my questions have been answered to my satisfaction. I understand that results vary and that additional sessions or maintenance treatments may be recommended for optimal results.

Release of Liability:

I release The Abram, its staff, and representatives from any liability related to this treatment, except in cases of proven negligence or intentional misconduct.

Photography and Records:

I understand that videos and photos will be taken for medical documentation purposes and will be used only for treatment comparisons and tracking progress milestones.

I agree that all the above information is true and accurate to the best of my knowledge

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