Instructions
This is an informed consent document that has been prepared to help inform you concerning human chorionic gonadotropin (hCG) injections and all supplementation tablets.
It is important that you read this information carefully and completely.
Introduction
hCG injections involves injecting yourself into the fat layer. hCG is a hormone that helps the body to release excess fat, hence releasing the calories in order for your body to use as energy. This injections combined with a low calorie diet assists the body to normalize abnormal Leptin levels. The process is assisted by supplementation by means of tablets adapted to every patient’s personal needs. Alternatively hCG nasal spray is available when patient’s don’t want to inject and has the same effect.
Risks
Every procedure involves a certain amount of risk, and it is important that you understand the risks involved. An individual’s choice to undergo a procedure is based on the comparison of the risk to potential benefit. Although most patients do not experience these complications, you should discuss each of them with your medical aesthetic physician to make sure you understand the risks, potential complications and consequences of hCG injections and hCG nasal spray.
- Patients who are using substances that can prolong bleeding, such as aspirin or ibuprofen, as with any injection, may experience increased bruising or bleeding at the injection site.
- You should inform your physician before treatment if you are using these types of substances.
- Infection is unusual. Should an infection occur, additional treatment including antibiotics may be necessary.
- There is the possibility of an unsatisfactory result after the use of the injections.
- The injection may cause a burning sensation upon injecting.
- Each patient’s hormones and genetics are different, therefore weight loss will vary from person to person.
- The supplements every patient receives will be discussed with the patient by the doctor and also the possible side effects.
- Patient should inform doctor of medical conditions, medication usage, previous cancers and possibility of pregnancy.
- Inform the Medical physician if you ever had an allergic reaction before especially for hCG.
Additional treatment necessary
The practice of medicine is not an exact science. Although satisfactory results are expected, there cannot be any guarantee or warranty expressed or implied on the results that may be obtained.
Dr Inge van Dyk gives a recommended additional diet plan menu and shopping list which is not part of the Medi-Lean program.
Disclaimer
Informed-consent documents are used to communicate information about the proposed treatments of a condition along with discloser of risk and alternative forms of treatment(s). The informed consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients in most circumstances.
However, informed-consent documents should not be considered all inclusive in defining other methods of care and risks encountered. Your medical aesthetic physician may provide you with additional or different information which is based on all the facts in your case and the state of medical knowledge.
Informed consent documents are not intended to define or serve as the standard of medical care. Standards of medical care are determined based on all the facts involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve.
It is important that you read the above information carefully and have all your questions answered before signing this consent.
The information mentioned by me is true and correct. I acknowledge the risks associated with treatment have been explained and all questions asked and answered satisfactory. I confirm that Dr or any of the staff members shall have no liability, vicarious or otherwise, for any loss of damage, harm or injury which I may suffer in consequence of agreeing to accept such treatment. I acknowledge that I am fully responsible for the payment of treatment within thirty days.
Accounts is not paid by the medical aid.
I have read a copy of page 1 and 2 of the foregoing consent for the procedure, understand it, accept these facts, and
thereby authorize the doctor to give adequate treatment for weight loss.
Please continue to the Medilean Pre-screening Questionnaire.