SEMAGLUTIDE WAIVER
By signing this waiver, I acknowledge that I am willingly enrolling in the Semaglutide Weight Loss Program provided by New Gen Medical. I am aware that this program incorporates the utilization of Semaglutide & Tirzepetide medication as an alternative approach to weight loss. Prior to commencing the program, I understand and agree that it is necessary for me to undergo a weight loss consultation with Dr. Zhukovski.
I have been informed and understand the following:
1. Program Details:
The Semaglutide weight loss program is designed to aid in weight loss and improve overall health through the use of medication and comprehensive medical guidance.
Semaglutide, also known as Ozempic, is a glucagon-like peptide-1 (GLP-1) analog that was approved in 2020 as a treatment method for improving glycemic control in patients with Type 2 diabetes. Semaglutide shows great promise for patients who are having difficulty losing weight.
Studies have demonstrated that Semaglutide reduced appetite, improved control of eating, and reduced food cravings in addition to improved glycemic control. The greatest weight loss benefits were observed when Semaglutide is used in combination with lifestyle changes, such as improved diet and consistent exercise.
2. Consultation:
I will participate in a weight loss consultation with Dr. Zhukovski & weightloss specialist Danielle Guralnik, during which my medical history, current health status, medication list, and weight loss goals will be assessed. They will provide personalized advice and guidance tailored to my specific needs.
3. Medication Use:
Semaglutide is a prescription medication that helps with weight loss. It works by suppressing appetite and promoting a feeling of fullness. I understand that the use of these medications will be closely monitored and adjusted as necessary under the supervision of Dr. Zhukovski & Danielle Guralnik. It is important to recognize that the medicine prescribed, Semaglutide, is primarily intended for diabetes treatment and is being used off-label for weight management purposes. Consequently, New Gen Medical does not provide refunds in the event of side effects or if the desired weight loss results are not achieved.
4. Potential Benefits:
I am aware that the Semaglutide Weight Loss Program may result in weight loss, improved glycemic control, increased energy levels, and other positive health outcomes. However, individual results may vary, and specific benefits cannot be guaranteed.
5. Potential Risks:
I acknowledge that there may be potential risks and side effects associated with the use of Semaglutide. The most common side effects reported include nausea, vomiting, diarrhea, stomach pain, and constipation. The risk of serious side effects increases in patients with hypoglycemia, kidney problems, diabetic retinopathy, and risk of allergic reactions. I understand that it is essential to promptly report any adverse effects or concerns to Dr. Zhukovski evaluation and management.
Important Safety Notice: This medication carries a Black Box Warning - Risk of Thyroid C-Cell Tumors with Semaglutide Use in Animal Studies. It is strictly contraindicated in those with a personal and family history of thyroid cancer, and in multiple endocrine neoplasia type 2.
6. Storage, Supply, and Administration of Semaglutide:
Our Semaglutide is conveniently provided in pre-portioned syringes, ensuring easy administration for your weekly injections. At New Gen Medical, our team members will guide and demonstrate the proper technique for self-administering a subcutaneous injection. To maintain the potency and integrity of the medication, it is important to store Semaglutide in the refrigerator. By keeping it at a cool temperature, you can ensure that the medication remains effective until it's time for your next injection. Our team will provide you with detailed instructions on proper storage and handling to help you maintain the quality of the medication.
7. Compliance:
I agree to follow the prescribed treatment plan, including medication administration, dietary recommendations, exercise guidelines, and any additional instructions provided by Dr. Zhukovski. I understand that adherence to the program is crucial for achieving optimal results. We begin with an initial dose of 0.25mg once weekly. The dosage may be increased monthly, as necessary and determined by the results. Please be aware that it is not possible to bypass the starting dose.
8. Responsibility:
I take full responsibility for my participation in the Semaglutide Weight Loss Program and any potential outcomes that may arise. I understand that weight loss results can vary and that success depends on my commitment, lifestyle modifications, and adherence to the recommended program.
9. Patient Acknowledgment:
By signing this patient waiver, you are acknowledging that the outcomes of the treatment cannot be guaranteed. It is important to recognize that the medication prescribed for weight loss is primarily intended for diabetes treatment and is being used off-label for weight management purposes. Consequently, New Gen Medical does not provide refunds in the event of side effects or if the desired weight loss results are not achieved. If you experience side effects, please contact our office, and we will provide guidance on appropriate measures, which may include prescribing an anti-nausea medicine or arranging for the administration of IV fluids, with associated costs involved.
By signing below, I acknowledge that I have read and understood the information provided in this waiver. I am aware of the potential risks and benefits associated with the Semaglutide Weight Loss Program and willingly consent to participate.