325 Rolling Oaks Dr, Suite 220

Thousand Oaks, CA 91361

Peptide Therapy Consent Form

Peptides are small chains of amino acids that can have biological activity. They are mostly naturally occurring. Some peptides are FDA approved for the treatment of certain diseases. Other peptides used clinically are prepared by duly registered compounding pharmacies complying with all state and federal laws. Peptides can be administered in various presentations, including but not limited to oral, intravenous, subcutaneous, intramuscular and intranasal routes.

Understanding this, I hereby acknowledge and consent to the following:

As with any other drug, peptide therapies can have side effects, including but not limited to:

  • Nausia

  • Vomiting

  • Feaver

  • Injection site reactions (pain, rash, bleeding)

  • Allergies, including life threatening allergies

  • Additional side effects not listed

  • Do nothing

  • Standard medication use

  • Surgery or other therapeutic intervention