Informed Consent 2 of 2 – Your Labwork – Leading Authority in Naturopathic Endocrinology
Informed Consent 2 of 2 – Your Labwork

Some of the potential side effects to treatments and therapies are but are not limited to:

    • Bruising/Local Tenderness (with venipuncture, acupuncture, manipulation, and other)
    • Allergy (with drugs, supplements, anesthesia, nutritional IVs, chelation, and other)
    • Drug Side-effects (with drug, supplements, herb-drug interactions)
    • Fainting (with supplements, acupuncture, nutritional IVs, chelation, and other)
    • Infection (with acupuncture, minor surgeries, venipuncture, implants, injections and other)
    • Burns (with cryosurgery, infrared therapy, and other)
    • Scars (with cryosurgery, acupuncture, moxabustion, venipuncture, hormone implants, minor surgery, and other)
    • Vaginal Bleeding in females (with hormone balancing and replacement therapy)
    • Fractures, Dislocation, Sprains, Disk Injuries (with manipulation, and other)
    • Strokes (with manipulation, and other)
    • Organ Puncture (with acupuncture, prolotherapy, minor surgery, and other)
    • Organ Failure (with IV chelation, detox, and other)
    • Dizziness, weakness, lightheaded (with injections, IV, prolotherapy, PRP, hormone implants, and other)

We have a wonderful referral network. Your doctor will inform you of alternatives to the above-mentioned therapies. Your health and well-being is our first concern. Please inform your doctor of any medication change, new allergies or if there is a possibility of pregnancy at any time during your treatment.

Integrative Health is a facility that occasionally finds it necessary to prescribe medications deemed “controlled” by the Drug Enforcement Agency (DEA). They have been given this designation because of their risk for causing dependency. For your own protection, it is important that you understand that these types of medicines can be used safely and can help to improve your ability to complete your daily activities; however, all medications have possible side effects. Please be sure to understand these potential side effects before starting any medication but especially any controlled substance.
Hormone Replacement Therapy

All medical treatments have potential side effects. The most common side effects are generally mild and temporary, and may include: overproduction of red blood cells, decreased testosterone and/or sperm production and testicular shrinkage, fluid retention, acne and hair thinning.

I acknowledge, understand and agree that testosterone is intended to lessen or eliminate the signs and symptoms of low testosterone, and to lessen the risk of diseases associated with testosterone deficiency. I acknowledge, understand and agree that testosterone therapy is not accompanies by any guarantees, promises or warrantees.

I hereby consent to get a full physical exam including PSA lab testing, digital rectal exam, PAP, mammogram, complete wellness panel as my doctor orders.

I acknowledge and understand that hormone replacement therapy, specifically testosterone, is DEA schedule III controlled substance and will require a follow up with my physician and follow up with my physician every 6 months to continue the prescription.

  • Date Format: MM slash DD slash YYYY
Share Health...Share on Facebook
Email this to someone
Tweet about this on Twitter