I understand that I am electing to participate in peptide therapy, which may involve the prescription, dispensing, recommendation, or administration of one or more peptide compounds. This consent applies to all peptide therapies offered now or in the future by Wright Health and Wellness LLC.
Nature of Peptide Therapy
Peptides are short chains of amino acids that may influence physiological processes. Many peptides are not FDA approved, may be research-use-only or physician-use-only, and may be experimental or investigational.
No Guarantee of Results: No outcomes or benefits are guaranteed.
Known and Potential Risks and Side Effects
Risks include but are not limited to:
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Injection site reactions
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Allergic reactions
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GI upset
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Fatigue and insomnia
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Metabolic and hormonal changes
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Cardiovascular effects
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Neurologic symptoms
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Immune dysregulation
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Musculoskeletal discomfort
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Potential oncologic risks
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Reproductive and pregnancy risks
Research and Regulatory Status: Many peptides are not FDA approved and lack long-term safety data.
Alternative Treatment Options
I understand that I have other options, including but not limited to:
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No treatment at all
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Lifestyle modification
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FDA approved therapies
Patient Responsibilities
I understand and agree that I am responsible for:
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Accurate disclosure of my medical history, conditions, medications, and allergies.
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Adherence to instructions for dosage and administration as directed.
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Follow-up appointments and monitoring as recommended by my provider.
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Adverse event reporting — promptly informing my provider of any side effects.
Assumption of Risk and Release of Liability
I voluntarily assume all risks and release Wright Health and Wellness LLC and its providers from liability to the fullest extent permitted by law.
Important: Do not sign this form unless you have read it carefully and understand the information above.
Acknowledgment and Consent
By signing below, I consent voluntarily. Please complete the fields below and sign electronically to submit your consent.
Sign Here
Sign inside the box below using your mouse or finger.
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By submitting this form, I confirm that the information entered is accurate and that I voluntarily consent to treatment.
