Nature of Phentermine Treatment
- Purpose of Phentermine
- Phentermine is an FDA-approved prescription medication for short-term weight
management.
- It is most effective when used alongside a reduced-calorie diet, regular exercise,
and behavioral modifications.
- Duration and Use
- Phentermine is intended for short-term use only (typically 12 weeks or less/In rare
cases with Physician approval we can additional 3 months also ).
- It is not suitable for patients with certain medical conditions or those with a
history of substance abuse.
Potential Risks of Phentermine
- Cardiovascular Risks
- Increased heart rate, elevated blood pressure, and the potential for heart-related
complications, including chest pain or palpitations.
- Central Nervous System Effects
- PNervousness, restlessness, dizziness, insomnia, or mood changes.
- Dependency and Abuse
- Phentermine is a Schedule IV controlled substance with a risk of dependency (If
continued for a long period of time),
tolerance and withdrawal.
- Other Adverse Effects
- Gastrointestinal disturbances (e.g., dry mouth, constipation), allergic reactions,
or more severe complications in rare cases.
- Interactions
- Potential adverse interactions with other medications, over-the-counter drugs, or
supplements.
Eligibility Criteria
By reading & signing this consent form while booking my appointment, I confirm
that:
- I am not pregnant, breastfeeding, or planning to become pregnant during treatment.
- I have disclosed all medical conditions, including but not limited to:
- High blood pressure
- Heart disease or arrhythmias
- Glaucoma
- Hyperthyroidism
- Psychiatric conditions or history of drug/alcohol abuse
- I have informed the provider of all medications and supplements I am currently taking.
- I understand that phentermine may not be appropriate for individuals with certain health
conditions or those taking contraindicated medications.
Acknowledgment of Risks and Responsibilities
- I understand the benefits, risks, and limitations of phentermine and telehealth services.
- I acknowledge that weight loss and maintenance require long-term commitment to lifestyle
changes.
- I will notify the provider immediately of any adverse effects, symptoms, or concerns during
treatment.
- I understand that misuse or sharing of phentermine is illegal and potentially dangerous.
Patient Privacy and Confidentiality
I understand that all telehealth services comply with HIPAA regulations to protect my health
information. However, there are inherent risks to electronic communication, such as data
breaches or unauthorized access, which I acknowledge and accept.
Consent and Agreement
I confirm that:
- I have read and fully understood the information provided in this consent form.
- I have had the opportunity to ask questions, and all of my questions have been answered to
my satisfaction.
- I voluntarily consent to telehealth services and the potential prescription of phentermine.
- I acknowledge that I may withdraw my consent or discontinue treatment at any time by
notifying my provider.
This form is intended to comply with all applicable federal and state laws governing telehealth
and controlled substances.