Please  FULLY AND CAREFULLY  the following information:

• Why Ozempic injections?

• The main benefits may include:

  1. Ozempic (Semaglutide) is 94% similar to natural human GLP-1 and therefore acts as a physiological regulator of appetite and thereby reducing food intake by reducing feelings of

  hunger and increasing feelings of fullness/satiety. The exact underlying mechanism of action is

  2. Ozempic is a newly licensed medication indicated for the treatment of type-2 diabetes. It is currently undergoing clinical trial to gain a license for the treatment of obesity. In the meantime, your medical practitioner may prescribe this medication for you 'off-label'

  3. For long term success the treatment needs to be combined with lifestyle changes including nutritional, exercise and behavioral habits.

  4. Weight loss can lead to secondary benefits by improving weight loss related health problems such as cardiovascular risk factors (including hypertension, blood glucose levels and waist circumference) and physical health-related Quality of Life.

  I understand that I have the right to be informed of the procedure, any feasible alternative options, and the risks and benefits. Except in emergencies, procedures are not performed until I have had an opportunity to receive such information and to give my informed consent.

  Since every human being is unique, we cannot guarantee any specific result from Ozempic treatment. Medication and or medical conditions may have a negative impact on the outcomes as well as lifestyle factors. Treatment should be discontinued after 12 weeks if the patient has not lost at least 5% of their initial body weight.

  Patients need to follow the instructions carefully as provided separately in the patient instruction sheet. Patients must agree to notify their practitioner of any contraindications or side effects of the treatment.

  We will write to your GP to notify them of details of the program and any blood results (if completed

  It is essential to engage with the 2 weekly telephone review and monthly face-to-face reviews with your doctor throughout the treatment program.

• HEALTH CONCERNS: If you suffer from a medical or pathological condition, you need to consult with an appropriate healthcare provider such as your GP or Consultant. If you are under the care of another healthcare provider, it is important that you inform your other healthcare providers of your use of Ozempic. If you are using medications of any kind, you are required to alert us of.

  Note: If you have any physical or emotional reaction to Ozempic treatment, discontinue use immediately, and contact your PRACTITIONER to ascertain if the reaction is adverse or an indication of the natural course of the body's adjustment to the treatment.

  Laboratory testing may be done to any patient identified at risk to determine areas of dysfunction, not to diagnose or treat. Potential blood tests:

  1. Full blood count
  2. Liver function test
  3. Kidney Function Tests
  4. Cholesterol levels, HbA1c, Glucose

  Patient groups who may require blood test monitoring at additional cost:

  • Age 50 or above
  • High blood pressure
  • Pre-Diabetics
  • Any significant medical problem

Semaglutide is a human-based glucagon-like peptide-1 receptor agonist prescribed as an adjunct to a
reduced calorie diet and increased physical activity for chronic weight management in adults with an
initial body mass index (BMI) that is considered outside a healthy range.
While using Semaglutide, it is highly recommended that you:
♣ Eat a fibrous diet. Focus on fruits and vegetables that are high in fiber.
♣ Eat small high protein meals as digestion is slowed down while on this medication.
♣ Avoid foods high in fat as they take longer to digest.
♣ Limit alcohol intake as this medication can lower blood pressure.
♣ Drink at least 32oz of water a day to avoid constipation.
Do not take this medication if:
♣ You have a personal or family history of medullary thyroid carcinoma (Thyroid Cancer)
♣ Multiple Endocrine Neoplasia syndrome type 2
♣ You are pregnant or plan to become pregnant while taking this medicine.
♣ You are diabetic and/or taking any medications related to lowering your blood sugar levels without
speaking with your endocrinologist.
♣ Specifically, if you are prescribed Insulin because the combination may increase your risk of
hypoglycemia (low blood sugar) and dosage adjustments by your provider may be necessary.
♣ You have a history of Pancreatitis.
♣ You are allergic to BPC-157, Semaglutide or any other GLP-1 agonist such as: Adlyxin®, Byeta®,
Bydureon®, Ozempic®, Rybelsus®, Trulicity®, Victoza®, Wegovy®;
♣ If you have other allergies. This product may contain inactive ingredients, which can cause allergic
reactions or other problems. Talk to your pharmacist for more details. Before using this medication, tell
your doctor/pharmacist your medical history.
Possible drug interactions: Anti-diabetic agents, specifically: Insulin and Sulfonylureas (e.g., g lyburide,
glipizide, glimepiride, tolbutamide) due to the increased risk of hypoglycemia (low blood sugar). Do not
take with other GLP-1 agonist medicines such as: Adlyxin®, Byeta®, Bydureon®, Ozempic®, Rybelsus®,
Trulicity®, Victoza®, Wegovy® (THIS IS NOT AN ALL-INCLUSIVE LIST). Other medications used in diabetes,
please tell your provider about any medications that may lower your blood sugar.
Possible side effects: Nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue,
dyspepsia, dizziness, abdominal distension, belching, hypoglycemia, flatulence, gastroenteritis, and
gastroesophageal reflux disease. Subcutaneous Injections: common injection site reactions characterized
by itching, burning at site of administration with or without thickening of the skin(welting). If you notice
other side effects not listed above, contact your doctor or pharmacist.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any
symptoms of a serious allergic reaction, including rash, itching/swelling (especially of the
face/tongue/throat), severe dizziness, trouble breathing. Report adverse side effects to your doctor or
pharmacist. In the event of any emergency, call 911 immediately.
IF YOU HAVE ANY QUESTIONS AS TO THE RISKS OR HAZARDS OF THIS TREATMENT, OR ANY QUESTIONS
CONCERNING THIS PROPOSED TREATMENT OR OTHER POSSIBLE TREATMENTS, ASK THE STAFF NOW
BEFORE SIGNING THIS CONSENT FORM.
By signing, I certify that I have read and understand the contents of this form. I acknowledge that I have
a proper laboratory /CBC done prior to starting treatment. I am aware of the possible side effects and
drug interactions and give my consent for treatment. I have informed the medical staff of any known
allergies to drugs or other substances, and any past adverse reactions I’ve experienced. I have informed
the medical staff of all medications and supplements I’m currently taking. I understand there are other
ways and programs that can assist me in my desire to decrease my body weight and acknowledge that
no guarantees have been made to me concerning my results.