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• I understand that Semaglutide is a prescription medication used for weight management and/or blood sugar control.
• I have disclosed my complete medical history, including any history of pancreatitis, gallbladder disease, thyroid cancer, or multiple endocrine neoplasia (MEN2).
• I understand that possible side effects may include nausea, vomiting, diarrhea, abdominal pain, constipation, and rarely, more serious complications such as pancreatitis or thyroid tumors.
• I understand that Semaglutide is not approved for use during pregnancy or breastfeeding.
• · I agree to follow the prescribed dosing schedule and attend recommended follow-up appointments and lab testing.
• I acknowledge that results vary and weight loss or other benefits are not guaranteed.
• I understand this is a medical treatment that requires monitoring and should only be used under the supervision of a licensed provider.

• I understand that Testosterone is a prescription medication used for the treatment of low hormone levels and related symptoms.
• I have provided my complete medical history, including any history of prostate cancer, breast cancer, heart disease, stroke, blood clots, liver disease, or sleep apnea.
• I understand that possible side effects may include acne, hair loss, mood changes, breast tenderness, increased red blood cell count, prostate changes, and changes in fertility.
• I understand Testosterone therapy may reduce sperm production and affect future fertility.
• I understand that Testosterone therapy requires ongoing monitoring, including lab work and follow-up visits.
• I acknowledge that results vary and symptom improvement is not guaranteed.
• I understand this treatment must be prescribed and monitored by a licensed medical provider.

• Telehealth involves the use of electronic communications to enable healthcare services when I am not in the same location as my provider.
• I understand the benefits (such as convenience and accessibility) and potential risks (including technical failures, limited physical examination, and privacy concerns).
• My medical information will be protected under HIPAA and applicable privacy laws, but electronic communication may still carry some risks.
• I have the right to stop or refuse telehealth services at any time without affecting my right to future care.
• I understand that my provider may determine telehealth is not appropriate for my condition and recommend in-person care.
• I consent to receive care and treatment via telehealth.