Peptide Therapy Informed Consent

I seek the medical services of Live Vital and its employees. I am executing this consent to confirm my prescription by my Live Vital medical provider and my understanding of the risks, benefits, and alternatives to treatment with peptide therapy.

The goal and possible benefits of this therapy may be to prevent, reduce or control the dysfunction associated with the aging process, through hormonal balancing, control of oxidative stress, and other clinically significant therapeutic agents.

I understand and acknowledge that no guarantees, warranties, or assurances have been made regarding the outcome of peptide therapy. However, I understand that this treatment may be deemed as new, controversial, off-label, experimental, and unapproved by the Food and Drug Administration ("FDA").

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. Commonly used peptides include: BPC 157, TB 500, GHK-cu, CJC/Ipamorelin, Tesamorelin/ipamorelin, Sermorelin, Tesamorelin, Tirzepatide, Semaglutide, Gonadorelin, HCG, AOD9604, 5 Amino 1 MQ, MOTs-C, SS-31, NAD+, Glutathione, and others as deemed appropriate.

Peptide therapy for the purpose of preventative care, weight loss, performance enhancement, anti-aging, and any additional condition is considered by the FDA to be "off-label use."

I acknowledge that Live Vital is not responsible for any manufacturing issues related to peptides prepared by compounding pharmacies and that the sole responsibility for sterility, potency, and safety lie with these pharmacies.

I understand that peptide therapies are not necessarily approved for my medical conditions and they are not a medical necessity, rather, they are an adjunctive and complimentary therapy to my treatment plan. Therefore, I acknowledge that it is an elective treatment option.

I understand that the use of these peptides is not necessarily approved for my medical conditions and that my physician is providing this, following the principles of the practice of medicine and the laws regulating compounding pharmacies, as a complement to my current treatments.

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

Nausea

Vomiting

Fever

Injection site reactions (pain, rash, bleeding)

Allergies, including life threatening allergies

Additional side effects not listed may also occur.

I understand that alternatives to peptide therapy are:

Do nothing

Standard medication use

Surgery or other therapeutic intervention

Seek out other specialist opinion

I understand that my treatment will be prescribed in an effort to prevent any side effects but cannot be guaranteed that I will not experience any side effects or adverse reactions. I understand that, as with any health treatment, there is no guarantee I will obtain satisfactory results through the use of this therapy. I understand the use of this treatment does not preclude me from using other treatments as well, though I recognize that I should inform any practitioners I am seeing about the various treatments I am using.

I understand that peptide therapy may be inappropriate or unsafe if I have certain health conditions or take certain medications or supplements. I agree to truthfully and accurately disclose all health information requested by my Live Vital Provider and to update my Provider regarding any changes. There shall be no liability on the part of Live Vital or its Providers if I fail to do so.

I agree to adhere to all safety precautions and instructions after the treatment. I have been instructed in and understand post treatment instructions and have been given a written copy of them.

I understand that no refunds will be given for treatments received regardless of results or lack of results. No guarantee has been given or implied by anyone as to the results that may be obtained from this treatment.

I also understand that Live Vital and my medical provider is not responsible for any manufacturing issues related to these peptides, such as sterility and potency, which are the sole responsibility of the compounding pharmacy preparing them.

I knowingly and voluntarily assume all known and unknown risks associated with peptide therapy, including risks that may arise from:

Off-label use

Compounded formulations

Limited or evolving scientific evidence

I accept full responsibility for my decision to proceed. To the fullest extent permitted by law, I agree that Live Vital, its physicians, staff, contractors, and affiliates shall not be liable for any injury, loss, complication, or adverse outcome arising from or related to peptide therapy, except as otherwise prohibited by applicable law.

I understand that this consent does not waive rights that cannot legally be waived, including claims arising from gross negligence or willful misconduct, where such waiver is prohibited.

I expressly agree that any dispute, claim, or controversy arising out of or relating to peptide therapy shall not be subject to mandatory arbitration. Any such dispute shall be resolved exclusively in a court of competent jurisdiction, under the laws of the state in which treatment is provided, unless otherwise required by law.

I understand and acknowledge that no guarantees, warranties, or assurances have been made regarding the outcome of peptide therapy.

I certify that I have read the foregoing Informed Consent, discussed the issues noted above, had opportunities to ask questions, and agree and accept all of the terms above. I hereby agree to the document above.