Consent to Treatment

Treatment Authorization and Informed Consent

This Treatment Authorization and Informed Consent authorizes Integrative & Age Management Medicine, PLLC (“IAM”) and its licensed clinical staff to provide medical evaluation and treatment as outlined below. By proceeding, you acknowledge that you have read, understand, and consent to the terms of this authorization.

Authorization for Treatment

You authorize licensed IAM providers and clinical staff to perform medical evaluations, order laboratory tests, and prescribe treatments that may include, but are not limited to: hormone optimization: testosterone replacement therapy, estrogen therapy, and thyroid hormone management; peptide therapy: including BPC-157, PT-141, and other peptides as clinically indicated; medical weight management: GLP-1 receptor agonists, semaglutide, tirzepatide, and supporting nutritional and lifestyle guidance; and sexual health treatments: as clinically appropriate based on your evaluation and goals.

Risks & Benefits

All medical treatments carry potential risks as well as potential benefits. You acknowledge that your provider has discussed or made available information regarding: possible side effects associated with prescribed medications and therapies, which vary by treatment and individual patient factors; the potential for drug interactions between prescribed medications and other substances you may be taking; the risk of allergic reactions, which may range from mild to severe; the possibility that a given treatment may not produce the desired response or may need to be adjusted or discontinued; and the need for ongoing laboratory monitoring to assess treatment safety and effectiveness.

You are encouraged to ask questions about any aspect of your treatment plan before proceeding.

Patient Responsibilities

To support the safe and effective delivery of your care, you agree to: provide complete and accurate medical history, including all current medications, supplements, allergies, prior diagnoses, and relevant family history; follow your prescribed treatment plan as directed by your provider, including dosage instructions and administration guidelines; report any adverse effects, unexpected symptoms, or changes in your health to IAM promptly; inform your provider of any changes to medications, supplements, or health status that occur during your treatment; complete all recommended laboratory tests in a timely manner to allow for safe monitoring of your treatment; not share, transfer, or allow others to use your prescribed medications under any circumstances; and attend scheduled follow-up consultations as recommended by your provider.

No Guaranteed Outcomes

IAM provides personalized treatment plans based on your individual health profile, goals, and clinical assessment. However, medical treatment results vary by individual, and no specific outcome, result, or benefit is guaranteed. Your response to treatment may differ from that of other patients receiving similar therapies.

Right to Refuse or Discontinue

You have the right to refuse any recommended treatment or to discontinue treatment at any time without affecting your right to receive other services from IAM. You are encouraged to discuss your decision with your provider before stopping treatment, as certain medications may require a gradual tapering process to discontinue safely. IAM will not prescribe controlled substances or manage withdrawal from substances outside the scope of our services.

Contact

For questions about this authorization, use the contact form. Current patients should send treatment-plan questions through secure portal messages.