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Z Med Clinic

Z Medi Clinics and Z Medi Spa

LIPOTROPIC MIC– B12 INJECTIONS INFORMED CONSENT

Vitamin injections have been shown to be beneficial in helping to:

Reduce stress &fatigue, improve memory & cardio vascular health. They also assist the body in converting proteins, fats and carbohydrates into energy, thereby improving metabolism and promoting maintenance of a healthy body weight. Additionally, they are necessary to maintain healthy skin and eyes.

Vitamin injections are better absorbed by the body since they go directly into the blood stream. Alternatives to vitamin injections are oral vitamins, B12 patch,lozenges,liquid drops,and nasal spray.

  1. I understand there is risk of the following: diarrhea, upset stomach, nausea, a feeling of pain and a warm sensation at the site of the injection, a feeling, or sense, of being swollen over my entire body, headache and joint pain.
  2. If any of these side effects become severe or trouble some,I will contact my physician or mid-level provider immediately.
  3. I understand that although rare, vitamin injections can result in serious side effects. Although this is relatively rare occurrence, anyone taking vitamin injections should be aware of the possibility. Uncommon side effects include:
  • rapid heartbeat
  • chest pain
  • flushed face
  • muscle cramps and weakness
  • difficulty breathing and swallowing
  • dizziness
  • confusion
  • tight feeling sin the chest
  • hives, skin rashes
  • shortness of breath when there is no physical exertion and unusual wheezing, and coughing
  1. Before starting Vitamin injections, I will be sure to report to clinic staff if I am pregnant, lactating, or have any of the following conditions:
  • Leber’s disease
  • Kidney disease
  • Liver disease
  • An infection
  • Iron deficiency
  • Folic acid deficiency
  • Receiving any treatment that has an effect on bone marrow
  • Taking any medication that has an effect on bone marrow
  • An allergy to cobalt or any other medication, vitamin, dye, food or preservative.
  1. I understand that certain herbal products, vitamins, minerals, nutritional supplements,prescription and non-prescriptionmedicationsmayresultinsideeffectswhentheyinteractwithvitamininjections.
  2. I understand that I will be receiving a B12 vitamin injection or a Vitamin and Amino Acid injection consisting of Vitamin B12, methionine, inositol, and chlorine. This injection is common lyre erred to as a lipotropic injectionora MIC-B12“fat burner” injection.

I also understand that:

  1. The procedure involves inserting a needle into various areas of the body and the injection of vitamins and other homeopathic remedies.
  2. Risks of injection therapies include but are not limited to:
    1. Occasionally to commonly
  • Discomfort, severe pain, bruising, inflammation, injury and numbness at the site of injection.
  • Fatigue, dizziness, or light-head feeling after the injections.
  • Fainting or loss of consciousness during the procedure.
    1. Extremely rare
  • Severe allergic reaction, anaphylaxis, infection.

By signing below, I acknowledge that I have read the foregoing informed consent and agree to theVitamintreatmentwithitsassociatedrisks.Iherebygiveconsenttoperformthisandallsubsequentinjections with the above understood. I hereby release the ZMed Clinic doctors and/or my mid-level providers, staff members injecting the vitamins, officers, associates and the facility from liability associated with this procedure.

Consent to treatment by a physician extender: You may be evaluated and treated by a physician assistant (P.A.) or a nurse practitioner (N.P.) whose recommended care and treatment is subject to supervision and review by a licensed physician.

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