INFORMED CONSENT FOR GROWTH HORMONE PEPTIDES

• SERMORELIN ACETATE | GHRP THERAPY

As is the case with the administration of any Hormone Replacement Therapy, systemic or local allergic responses can sometimes result. It is vital that patient be aware that such responses can potentially occur. If the patient suffers an allergic reaction as a result of SERMORELIN ACETATE | GHRP THERAPY it is vital that they receive medical attention promptly. Clinical Tests have shown that increased blood-serum levels of Insulin-Like Growth Factor One (IGF-1), HumanGrowth Hormone, alkaline phosphatase, and inorganic mineral phosphorus can occur as a result of SERMORELIN ACETATE | GHRP THERAPY.

• DRUG INTERACTIONS

Taking glucocorticoid steroids in combination with SERMORELIN ACETATE | GHRP THERAPY may reduce the effectiveness of therapy.

• FERTILITY IMPAIRMENT, MUTAGENESIS, CANCER RISK

There has been no longitudinal animal research regarding fertility impairment or carcinogenicity risk regarding S SERMORELIN ACETATE | GHRP THERAPY. There has been absolutely no clinical research linking S SERMORELIN ACETATE | GHRP THERAPY to genetic abnormalities.

• PREGNANCY

There has been some animal research conducted regarding SERMORELIN ACETATE | GHRP THERAPY. At a dosage somewhere between three and six times the normal daily dosage that a human patient receives adjusted for physical surface area, minor fetal changes occurred in rabbits and rats. There have been no adequately controlled studies regarding the usage of SERMORELIN ACETATE | GHRP THERAPY by women who are pregnant. SERMORELIN ACETATE | GHRP THERAPY should NOT be administered to women that are pregnant.

• NURSING WOMEN

It is unknown if SERMORELIN ACETATE | GHRP is produced in human milk. There are many medications that are released by the mother in the nursing process, and for this reason mother sand physicians should exercise caution when using SERMORELIN ACETATE| GHRP THERAPY while nursing.

• SHARPS DISPOSAL INFORMATION

If the physician approves home usage, the patient should use SHARPS containers meant for the proper disposal of used needles and syringes accumulated as a result of SERMORELIN ACETATE| GHRP THERAPY. These containers are puncture resistant and are a necessary safety measure to protect both patient and anyone who may come in contact with the used needles and syringes. It is vital that patient (and parent, if applicable) be directed thoroughly as to the vital important of proper needle disposal. Also, they should be informed of the dangers of reusing syringes and needles as well.

• SIDE EFFECTS A significant portion of SERMORELIN ACETATE | GHRP THERAPY patients develop antibodies against Growth Hormone Factor during at least one point of therapy. There is no clear assessment of the significance of the presence of these antibodies, and the levels of these antibodies can change quickly from test to test. A positive result at one juncture regularly turns into a negative result after the next test. The production of these antibodies does not seem to have any adverse effect on the patient. Also, these antibodies do not seem to produce any change in the effectiveness of SERMORELIN ACETATE | GHRP THERAPY.

• ALLERGIC REACTIONS

There have been no reported general allergic responses to SERMORELIN ACETATE | GHRP THERAPY. The most common reaction to SERMORELIN ACETATE | GHRP THERAPY is related to local irritation around the injection site, which occurs in around one of every six patients. This irritation is characterized by redness, pain, or swelling. Though this side effect is relatively common, only a small minority of patients find the irritation bothersome enough to suspend therapy. Out of a sample of 350 patients who underwent SERMORELIN ACETATE| GHRP THERAPY in clinical trial, only three suspended therapy as a result of injection-site irritation. There are other side effects which occurred in less than one percent of patients. These side effects include: severe drowsiness, hives, vomiting, headache, nausea, difficulty swallowing, hyperactivity, chest tightness and pallor, distortion in perception of taste, and flushing of the skin.

• SERMORELIN ACETATE | GHRP THERAPY DEPENDENCY AND ABUSE

There is no evidence to suggest that the use of SERMORELIN ACETATE | GHRP THERAPY for any period of time will result in any sort of dependency or proclivity toward abuse. The general pharmacology of SERMORELIN ACETATE | GHRP THERAPY does not produce any addictive effect, and clinical trials have produced no evidence of such an effect.

• NEVER TAKE MORE THAN PRESCRIBED

It is not recommended to exceed the recommended dosage of SERMORELIN ACETATE| GHRP THERAPY prescribed by your physician. Overdose will not provide better results. It will only increase the occurrence of side effects.

• HORMONE THERAPY While hormones can be administered by applying creams to the skin, please be informed that some hormone therapies (typically require one subcutaneous injection (that is syringe injections- “shots” under the first few layers of skin) per day. Please be informed that there are certain risks associated with this procedure.

The risks include;

1. Water retention which may result in leg swelling;
2. Elevated blood pressure, which may be reversed with dose adjustment;
3. An initial mild increase in fasting blood sugar (if I am diabetic);
4. Bruises at the injection site; and
5. Infection at the injection site if improper techniques are used. By agreeing to undergo this therapy I accept these risks and freely agree to participate in this type of hormone therapy.Please be informed that the possible benefits of hormone therapy can include: controlling or stopping menopause or andropause symptoms; improving physical and mental shape; increasing energy; decreasing wrinkles; losing weight; an improved sex life; and sleeping more soundly.

Human Growth Hormone can affect cell metabolism and cell growth. For example, if a patient had an underlying and/or undetected cancerous growth prior to undergoing hormone therapy, the administration Sermorelin or other hormones could possibly induce further growth of the underlying cancer. Some studies contradict this theory but results are unknown.

• OFF-LABEL USE OF FDA-APPROVED DRUGS

Please be informed that hormone replacement therapy may include the “off-label” use of FDA approved drugs. “Off-label use” means an FDA approved drug is used in therapies and treatments for which the drug was not specifically approved. As much as forty-six per cent (46%)of certain classes of prescriptions are for off-label use of FDA-approved drugs. The reasonable alternatives to hormone replacement therapy have been explained to me and they include: (1)leaving the hormone levels as they are; and (2) treating diseases as they appear.

• RISKS: INFECTION, ANTIBODY PRODUCTION (REDNESS, SWELLING IN AREA OF INJECTION) ADDITIONAL UNKNOWN RISKS

1. Benefits of short- and long-term treatment: IMPROVED OVERALL HEALTH
2. Less-intrusive alternatives: EXERCISE & IMPROVED NUTRITION
3. The consequences of the cessation of treatment: NO KNOWN CONSEQUENCES OF DISCONTINUING TREATMENT
4. Financial costs associated with treatment: $315 each month (not including lab fees.)
5. Blood work required: CBC, BMP, IGF-1, PSA (men), PREGNANCY (women)• Follow-up Required: Monthly office visits with exam and interview of experience

Please be informed that we do not prescribe, order, dispense, administer, sell, or transfer Sermorelin or GHRP-2 to any person for the purpose of hormonal manipulation intended to increase muscle mass, strength, stamina, or weight; nor for use for body building, muscle enhancement, or increasing muscle bulk or strength by a person in good health for the intended purpose of improving performance in any form of exercise, sport, or game.

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• BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE INFORMED CONSENTBy signing, I hereby confirm that there have been no guarantees made to me regarding the outcome of any of the above described therapies. Also, the benefits derived from these therapies will stop if the therapies are discontinued. By signing below, I – the patient– assume full liability for any adverse effect that may result from the non-negligent prescribing of the neutraceuticals, antioxidants, hormones, drugs, or other treatments involved in the therapies and medical care prescribed or recommended by Physician and staff of RestoreMD Co.Also I waive and release any grievances, or damages (monetary or otherwise) arising from my treatment as her patient and release her from any and all claims.• By signing, I hereby confirm and attest that I am not under the jurisdiction of any governing body which prohibits the use of hormone and/or human growth hormone replacement therapy, such as sports organizations, competitive athletic/bodybuilding organizations, Olympic sports teams, or the like. By signing, I certify that I am under the care of another physician or physicians for all other medical conditions.
• By signing, I hereby understand, agree, and confirm that the therapies and treatments recommended by providers at RestoreMD Co. are elective. The risks involved and the possibilities of complications have been explained. I understand that any prescribed therapies and treatments are based on the medical judgment of physician and based on their individual expertise in this field of medicine. I understand that I may suspend or terminate treatment at any time; I hereby agree to immediately notify me medical doctor or provider at RestoreMD Co.office of any such suspension or termination.
• To attest to my consent to this treatment regimen and the releases stated above, I hereby sign this authorization for treatment. I acknowledge that there are no guarantees relating to the effectiveness of SERMORELIN ACETATE | GHRP THERAPY and that I have done my own research and have made a well informed decision to start the treatment and agree thatRestoreMD Co. and staff are not responsible for my individual performance or my ability toad here to the program. There are NO guarantees and there are NO REFUNDS. In fact, I acknowledge that I have done my own research and am requesting that the RestoreMD provide SERMORELIN ACETATE | GHRP THERAPY to me. Also, I have been counseled by ResoreMD physician about hormone therapy. All questions I had regarding hormone replacement therapy have been answered to my satisfaction. I understand that I will be responsible for injecting and administering any hormones prescribed tome. I agree to conform and comply with the recommended doses and methods of administration. I also agree to comply with any requests for initial and subsequent blood tests, as required, to monitor my hormone levels.

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