Weight Loss Forms & FAQ

Your body will recover more quickly and have optimal results when you maintain a regimen to support your health and well-being.

Pre-Treatment Advice:

Hydration: Drink 2 liters of water per day for one week before treatment to ensure proper hydration.
Blood Thinners: If using blood thinners, consult your medical provider about pausing them prior to treatment.
Skin Preparation: On the day of treatment, keep the skin clean and free of any lotions or perfumes.
Avoid Alcohol and Excessive Caffeine: Avoid alcohol and excessive caffeine for 48 hours before your appointment to reduce potential side effects.
Sun Exposure: Minimize direct sun exposure and avoid tanning beds for one week before treatment.

Post-Treatment Advice:

Fibrous Diet: Emphasize a fibrous diet, including fruits and vegetables high in fiber.
Injection Storage: Store the injections in the refrigerator and do not freeze. Dispose of used needles in a hard, closed container and keep this container away from children and pets.
Small, High-Protein Meals: Opt for small, high-protein meals, as digestion is slowed down while on this medication.
Caffeine: Be cautious with caffeine consumption, as it may affect the action of semaglutide, leading to low blood sugar levels or other side effects.
Low-Fat Foods: Avoid foods high in fat as they may contribute to nausea and vomiting. It is recommended to take injections before meals to minimize potential side effects from eating high-fat or high-sugar foods. Consultation will determine treatment cost based on area size and vial requirement.
Limit Alcohol Intake: Avoid alcohol consumption while taking semaglutide injections, as it can increase the risk of hypoglycemia, dehydration, nausea, and vomiting.
Dietary Tips for Nausea: Eat slowly in small portions, drink clear liquids, and avoid lying down right after eating. Focus on foods that contain more water and maintain a regular eating schedule while limiting snacking.
Hydration Post-Treatment: Drink at least half a liter of water immediately after treatment to aid in hydration and flushing out toxins.
Physical Activity: Maintain a healthy diet and engage in light exercise throughout the treatment course.

Risks:

Common Side Effects: Nausea, vomiting, diarrhea, constipation, and abdominal pain.
Injection Site Reactions: Redness, swelling, itching, pain, and tenderness.
Other Side Effects: Headache, dizziness, and fatigue.
Serious Risks: Pancreatitis, thyroid tumors, and severe allergic reactions.
Allergic Reactions: If you experience signs of an allergic reaction such as rash, itching/swelling, severe dizziness, or trouble breathing, seek immediate medical attention.

COMMON SIDE EFFECTS INCLUDE, BUT ARE NOT LIMITED TO:

Gastrointestinal: Nausea, vomiting, abdominal pain, diarrhea/constipation, dyspepsia, flatulence, abdominal distension, gastroenteritis, GERD, gastritis, lipase increase, amylase increase
Neurological: Headache, dizziness
Cardiac: Heart rate increase, hypotension
Endocrine: Fatigue, hypoglycemia (in diabetic patients), alopecia
Ophthalmic: Retinal disorder (in diabetic patients)
Skin: Redness or pain at injection site

SERIOUS REACTIONS INCLUDE, BUT ARE NOT LIMITED TO:

• Thyroid C-cell tumor (animal studies)

• Medullary thyroid cancer

• Hypersensitivity reaction

• Anaphylaxis

• Angioedema

• Acute kidney injury

• Chronic renal failure exacerbation

• Pancreatitis

• Cholelithiasis

• Cholecystitis

• Syncope

ALTERNATIVES AND CONTRAINDICATIONS:

I have the right to be informed of any alternative options, side effects, and the risks and benefits. I understand that alternatives may include dietary measures and increased physical exercise. Contraindications may include pregnancy or trying to become pregnant, certain medical conditions, and any known allergies.

TREATMENT PLAN AND EXPECTATIONS:

I understand the treatment plan, including the administration of the medication and the importance of adhering to the prescribed schedule. I have informed my provider of any known allergies, medical conditions, medications, social/family history, and any changes to my health status.

RESPONSIBILITIES:

I agree to obtain prescriptions for compounded semaglutide only from Glo MD Wellness. If transitioning to a non-compounding pharmacy or seeking insurance coverage, I will inform Glo MD Wellness in advance. I will provide my complete medical history and any updated health information. I will follow the prescribed directions for use and seek help if I experience any adverse effects or have trouble administering the medication.

REFILLS:

I understand that all refills will require an appointment and that I may need to schedule these ahead of time to avoid delays. I will not ask for early refills and understand that Glo MD Wellness may check the medication quantity at appointments.

SAFETY:

I will keep my medication away from children (<18 years old) and will not give or sell my medication to anyone else. If Glo MD Wellness deems it appropriate to start weaning my medication or transition to maintenance dosing, I will comply.

FINANCIAL RESPONSIBILITY:

I understand that the costs associated with compounded semaglutide may vary and that I am responsible for these costs, including consultation fees, procedure fees, and any additional treatments or follow-up appointments. My charge will include time with Glo MD Wellness, supplies, and medication.

DISCONTINUATION OF MEDICATION:

I understand that Glo MD Wellness may stop prescribing my medications if:
-I experience unfavorable side effects or if the medication is not working to treat my condition.
-I have been untruthful in my medical or family history.
-I do not follow the recommended plan of care.
-I do not adhere to the responsibilities outlined in this agreement.

Patient Consent:

I have read and understood the information provided in this consent form regarding compounded semaglutide. I have had the opportunity to ask questions, and my questions have been answered to my satisfaction. I voluntarily consent to undergo this procedure and acknowledge that I may withdraw my consent at any time. I have been given a copy of this consent form. My consent and authorization for this procedure are strictly voluntary. By signing this informed consent form, I grant authority to my practitioner to administer compounded semaglutide. The nature and purpose of this procedure, along with possible alternative methods of treatment and complications, have been fully explained to my satisfaction. No guarantee has been given by anyone as to the results that may be obtained by this treatment. I have had enough time to consider the information from my practitioner and feel that I am sufficiently advised to consent to this procedure.