BetterBody 360 logo with the text "HEALTH AND WELLNESS" below it.

1About You
2Health History
3Since Your Last Visit
4Conditions & Medications
5Consent
What was your sex assigned at birth?(Required)
Are you currently pregnant, breastfeeding or planning to become pregnant?(Required)

Consent (Pregnancy Risk):

I understand that the medication prescribed to me by my healthcare provider may not be safe to take during pregnancy. I acknowledge that taking this medication while pregnant could pose risks to my health and the health of a developing fetus.

I agree to take necessary precautions to avoid becoming pregnant while using this medication, including the use of effective contraception methods as discussed with my healthcare provider.

I understand that I should stop taking this medication before attempting to become pregnant. I agree to consult with my healthcare provider prior to discontinuing the medication and before planning a pregnancy to ensure my safety and well-being.

By selecting below, I confirm that I have read and understand the information provided above. I consent to proceed with the treatment under these conditions.

Pregnancy Risk Consent(Required)
Have there been any health changes, medication changes, ED visits or hospitalizations since your last check-in?(Required)
How are you doing on the current medication?(Required)
Are you still actively taking this medication?(Required)
Have you had any side effects from the current medication?(Required)
Do you currently have, or have you ever been diagnosed with, any of the following conditions?(Required)
Do you take any of the following medications?(Required)

Consent:

Medications such as sermorelin and tesamorelin are medications that may be prescribed to support your metabolism, though it is not FDA-approved for this specific use. Its application for metabolism support is considered off-label, meaning it is prescribed by your healthcare provider despite not being specifically approved by the FDA for this purpose. The purpose of this consent form is to ensure that you understand the following:

  • The reasons for using sermorelin or tesamorelin
  • The potential benefits and risks
  • The monitoring plan
  • Your responsibilities during treatment

Please read this document carefully.

Sermorelin and tesamorelin are being considered as a treatment option to potentially improve your metabolic support by acting as a synthetic analogue of growth hormone-releasing hormone (GHRH), which stimulates the secretion of growth hormone (GH). Growth hormone plays a critical role in:

  • Growth
  • Body composition
  • Cell repair
  • Metabolism

By promoting the natural production of GH, these medications may provide the following benefits:

  • Enhance muscle growth
  • Improve body composition
  • Boost energy levels
  • Support overall physical performance

It is commonly used for purposes like weight loss, muscle gain, and anti-aging therapy.

As previously mentioned, the use of sermorelin and tesamorelin to increase growth hormone levels is considered off-label. While legally prescribed, its is not an FDA-approved indication.

Like any medication, these comes with potential risks and side effects:

Common side effects:

  • Injection site reactions (pain, swelling, redness) if provided as an injection
  • Headaches
  • Flushing
  • Dizziness
  • Nausea

Less common but more serious risks:

  • Exacerbation of undiagnosed cancers
  • Significant changes in blood pressure
  • Increased intracranial pressure
  • Severe allergic reactions

There are also concerns regarding the long-term use and its potential link to increased cancer risk. While there is no definitive evidence directly linking these to cancer, some studies suggest that prolonged use of growth hormone therapies could potentially increase the risk of certain cancers due to hormonal imbalances. Since these products stimulate the production of growth hormone, it may influence the development of cancerous cells in susceptible individuals.

To ensure safety and effectiveness, regular monitoring is required during treatment including:

  • Blood tests every six months to monitor growth hormone levels
  • Regular symptom assessments to evaluate the medication’s effectiveness
  • Follow-up visits to discuss progress, side effects, and necessary adjustments to the treatment plan

You have the right to discuss and consider alternative treatments with your healthcare provider. These alternatives may include:

  • Lifestyle modifications (exercise, diet, sleep hygiene, stress management)

As a patient, you are responsible for:

  • Attending all scheduled follow-up appointments
  • Reporting any side effects or new symptoms to your healthcare provider
  • Adhering to the prescribed dosing regimen
  • Undergoing all required laboratory tests as part of the monitoring plan if needed

By selecting below, you confirm that you:

  • Have read and understood the information provided
  • Understand the potential risks and benefits of using sermorelin or tesamorelin, as well as its off-label nature
  • Agree to adhere to the monitoring plan and report any concerns or side effects to your healthcare provider
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