Lipotropic Injection and B12 Informed Consent

Lipotropic injections aid in weight loss by increasing your metabolism. Vitamin B-12 helps maintain optimal health and has been shown to be beneficial in reducing fatigue, improving memory, and maintaining a healthy body weight. It is what your body uses to create energy, which is one of the reasons people feel more energized when they take B12.

While all components of a lipotropic injection generally have no side effects, it's important to remember that all medications and supplements have potential side effects, including B12, methionine, inositol, choline, and amino acids. Most people tolerate B12 and lipotropic injections without issue, as side effects are rare.

Potential Common B12 Side Effects:

• Mild diarrhea
• Upset stomach
• Nausea
• Pain at the injection site
• Swelling
• Headache
• Joint pain

Potential Common Lipotropic Injection Side Effects:

• Stomach upset
• Diarrhea
• Urinary frequency/urgency/hesitancy
• Fatigue
• Elevated heart rate
• Restlessness

Acknowledgments:

1. Side Effects Notification:
   If I begin to have side effects, I will contact DIVINE HANDS HOME MEDICAL SERVICES immediately and notify them of what is happening.

2. Serious Side Effects of B12 Injections:
   Although rare, vitamin B12 injections can result in serious side effects. If these occur, I understand I should follow up with a medical provider or go to the emergency department immediately. Uncommon and dangerous side effects include:

   • Rapid heartbeat
   • Chest pain
   • Flushed face
   • Muscle cramps
   • Weakness
   • Difficulty breathing and swallowing
   • Dizziness
   • Confusion
   • Rapid weight gain
   • Feeling of tightness in the chest
   • Hives and rashes
   • Shortness of breath with no physical exertion
   • Unusual wheezing and coughing

3. Disclosure of Pre-existing Conditions:
   Before starting vitamin B12 and lipotropic injections, I agree to make DIVINE HANDS HOME MEDICAL SERVICES aware of any of the following conditions:

   • Leber’s Disease
   • Liver disease
   • Kidney disease
   • Iron deficiency
   • Folic acid deficiency
   • Cardiovascular disease
   • Receiving any treatment or taking any medication that affects bone marrow
   • Drug/supplement allergies

4. Potential Interactions:
   I understand that there could be interactions between B12, lipotropic injections, and certain medications/supplements.

5. Off-Label Use of B12 and Lipotropic Injections:
   The use of B12 and lipotropic injections on a weekly to biweekly basis, without a documented B12 deficiency, is considered off-label use and has not been FDA approved for increasing energy levels and weight loss.

6. Sulfa Allergy Warning:
   Caution is advised while taking B12 if you have a sulfa allergy.

Consent Statement:

By signing below, I acknowledge that I have read this informed consent and agree to the treatment with its associated risks. I hereby give consent for B12 and/or lipotropic injections. I agree to inform my medical provider immediately if I experience any side effects. I hereby release DIVINE HANDS HOME MEDICAL SERVICES, ELLA MENSAH, and the person administering the injection from any damages or liability if anything were to occur.