Informed Consent for B Vitamin and Lipotropic Injection Therapy

This document is intended to serve as confirmation of informed consent for injection therapy at Medical Weight Loss Centers of America.

I have informed Medical Weight Loss Centers of America of any known allergies to drugs or other substances, or of any past reactions to injections. I have informed the doctor of all my medical conditions and current medications. I understand that I have the right to be informed of the procedure, any feasible alternative options, and the risks and benefits. Except in emergencies, procedures are not performed until I have had an opportunity to receive such information and to give my informed consent.

I understand that:

  1. The procedure involves inserting a needle into various areas of the body   and injecting of vitamins and other homeopathic remedies.
  2. Risks of injection therapies include but are not limited to:
  3. Occasionally to commonly
  1. Extremely rare:

I am aware that other unforeseeable complications could occur. I do not expect Medical Weight Loss Centers of America to anticipate and or explain all risk and possible complications. I rely on the technician to exercise judgement during the course of treatment with regard to any procedure. I understand the risks and benefits of the procedure and have had the opportunity to have all of my questions answered. I understand that I have the right to consent to or refuse any proposed treatment at any time prior to its performance.

When purchasing Vitamin B or Lipotropic Injections from Medical Weight Loss Centers of America, you agree to the following: