Weight Loss Program Agreement

This Agreement is entered into by Prime Health Medical & Aesthetic and [Patient above] to outline the terms, conditions, and expectations of the customized weight loss program. By signing this Agreement, the Patient acknowledges and agrees to the terms specified below.

Program Overview

The weight loss program is designed exclusively for weight management and includes a combination of treatments customized to the Patient’s unique needs, body chemistry, and target goals. These treatments are not intended for the management or treatment of any underlying medical conditions and are focused solely on achieving weight loss.

1.Treatments and Services May Include:

• Comprehensive Assessments:

  • Blood work, BMI, metabolism analysis, fat percentage, and muscle percentage evaluation.

• Medications and Injections:

  • Prescription medications (e.g., Tirzepatide, Semaglutide) designed to assist with weight management by regulating appetite, improving metabolism, and reducing fat.

  • Hormonal or health-supporting injections (e.g., lipotropic or other supplements) intended to enhance weight loss outcomes, not to treat medical conditions.

• Procedures:

  • CoolSculpting or lipodissolving injections for targeted fat reduction.

• Diet and Exercise Plans:

  • A customized meal plan and exercise program to complement treatments.

• Support Services:

• One-on-one professional coaching and follow-ups to monitor progress and provide guidance.

2. Side Effects and Risks

Medications: Tirzepatide and Semaglutide

These injectable medications (e.g., Tirzepatide [Mounjaro], Semaglutide [Ozempic, Wegovy]) are used to assist with weight loss by regulating appetite and blood sugar levels.

Common Side Effects

• Gastrointestinal Issues:

  • Nausea

  • Vomiting

  • Diarrhea

  • Constipation

  • Abdominal discomfort

  • Indigestion

  • Bloating or gas

• Appetite Changes:

  • Decreased appetite

  • Early satiety

• Headaches

• Fatigue or Tiredness

• Dizziness

• Injection Site Reactions:

  • Redness

  • Swelling

  • Itching

  • Pain or tenderness

Less Common Side Effects

• Hypoglycemia (Low Blood Sugar):

  • Especially when combined with other diabetes medications

  • Symptoms: Sweating, shakiness, confusion, rapid heartbeat

• Gastroesophageal Reflux Disease (GERD):

  • Heartburn

  • Acid reflux

• Altered Taste Sensations

Rare but Serious Side Effects

• Pancreatitis (Inflammation of the Pancreas):

  • Severe abdominal pain radiating to the back

  • Nausea and vomiting

  • Requires immediate medical attention

• Gallbladder Disease:

  • Gallstones

  • Cholecystitis (gallbladder inflammation)

  • Symptoms: Abdominal pain, fever, jaundice

• Kidney Problems:

  • Acute kidney injury

  • Worsening of existing kidney disease

  • Symptoms: Reduced urine output, swelling, fatigue

• Thyroid Tumors:

  • Medullary thyroid carcinoma observed in animal studies

  • Risk in humans is not established but caution is advised

  • Symptoms: Neck mass, difficulty swallowing, hoarseness

• Allergic Reactions:

  • Rash

  • Itching

  • Swelling of face, lips, tongue, or throat

  • Difficulty breathing (anaphylaxis)

• Diabetic Retinopathy Complications:

  • Worsening of diabetic eye disease

  • Symptoms: Vision changes, floaters

Important Notes

• Contraindications:

  • Personal or family history of medullary thyroid carcinoma

  • Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)

• Monitoring:

  • Regular medical follow-up is necessary to monitor for side effects

CoolSculpting

CoolSculpting (cryolipolysis) is a non-invasive procedure that freezes and eliminates fat cells in targeted areas.

Common Side Effects

• Temporary Redness

• Swelling

• Bruising

• Firmness

• Tenderness or Pain

• Cramping

• Itching

• Tingling or Stinging Sensations

• Numbness of the Treatment Area:

  • Can last for several weeks post-treatment

Less Common Side Effects

• Fullness in the Throat:

  • If treated under the chin or neck area

• Muscle Weakness (Temporary)

Rare but Serious Side Effects

• Paradoxical Adipose Hyperplasia (PAH):

  • An unexpected increase in fat volume in the treated area

  • Area becomes larger and firmer

  • May require surgical intervention

• Late-Onset Pain:

  • Pain developing several days after treatment

  • Can persist for weeks

• Subcutaneous Induration:

  • Firmness or nodules under the skin

• Hyperpigmentation or Skin Discoloration

• Frostbite or Cold Burns (Very Rare)

• Vasovagal Symptoms:

  • Dizziness

  • Lightheadedness

  • Fainting

Important Notes

• Contraindications:

  • Cold-related conditions (e.g., cryoglobulinemia, cold agglutinin disease)

  • Paroxysmal cold hemoglobinuria

• Post-Treatment Care:

  • Follow provider's instructions to minimize side effects

 Lipo-Dissolving Injections

These injections (e.g., Deoxycholic acid [Linetro, Kybella]) dissolve fat cells in targeted areas, commonly under the chin, stomach area.

Common Side Effects

• Swelling at Injection Site

• Bruising

• Pain or Tenderness

• Redness

• Numbness or Hardness in the Treatment Area

Less Common Side Effects

• Firmness or Nodules Under the Skin

• Itching

• Headache

• Nausea

Rare but Serious Side Effects

• Nerve Injury in the Jaw:

  • Can cause an uneven smile or facial muscle weakness

  • Usually temporary but may last for months

• Difficulty Swallowing

• Ulceration or Skin Necrosis:

  • Skin breakdown if injected improperly

• Infection at Injection Site

• Allergic Reactions:

  • Rash, hives, difficulty breathing

Important Notes

• Proper Technique:

  • Must be administered by trained professionals to minimize risks

Diet and Exercise Plans

Customized plans are essential but may have side effects if not properly managed.

Potential Side Effects of Diet Changes

• Nutritional Deficiencies:

  • If the diet is overly restrictive

  • Symptoms: Fatigue, hair loss, weakness

• Gastrointestinal Issues:

  • Constipation or diarrhea

  • Bloating or gas

• Low Energy Levels

• Hypoglycemia (Low Blood Sugar):

  • Dizziness, shakiness, irritability

• Mood Changes:

  • Irritability, depression, anxiety

• Disordered Eating Patterns

Potential Side Effects of Exercise

• Muscle Soreness (DOMS)

• Injury Risk:

  • Sprains, strains, fractures

• Dehydration

• Fatigue

• Cardiovascular Events:

  • Rare but possible in individuals with heart conditions

Important Notes

• Professional Guidance:

  • Plans should be developed and monitored by qualified professionals

• Gradual Progression:

  • Increases in activity levels should be gradual to prevent injury

Hormonal or Health-Supporting Injections

Includes vitamin injections, lipotropic compounds, or other supplements.

Common Side Effects

• Injection Site Reactions:

  • Pain, redness, swelling

• Mild Gastrointestinal Upset

• Headache

Less Common Side Effects

• Joint Pain

• Allergic Reactions:

  • Rash, itching

Rare but Serious Side Effects

• Anaphylaxis:

  • Severe allergic reaction requiring immediate medical attention

• Kidney or Liver Issues:

  • In individuals with pre-existing conditions or overdose

Important Notes

• Medical History:

  • Disclose all health conditions to the provider

• Monitoring:

  • Regular assessments may be necessary

General Risks Across All Treatments

Psychological Effects

• Emotional Distress:

  • If expectations are not met

• Body Image Issues

Medication Interactions

• Potential Interactions:

  • With current medications or supplements

Complications from Underlying Conditions

• Exacerbation of Health Issues:

  • Existing medical conditions may be affected

Important Notes

• Open Communication:

  • Inform the provider of all medications and health concerns

• Informed Consent:

  • Understand all risks before proceeding

Key Points for Patients

• Adherence Is Crucial:

  • Following all instructions maximizes benefits and minimizes risks

• Report Side Effects Promptly:

  • Early reporting allows for timely management

• Regular Monitoring:

  • Attend all scheduled follow-ups

• Lifestyle Integration:

  • Combine treatments with healthy lifestyle choices

3. Patient Responsibilities

1. The Patient agrees to:

   1. Adhere to All Treatment Instructions:

      • Attend all scheduled appointments, including weekly injections.

      • Follow the prescribed diet and exercise plans and provide regular updates or reports on adherence.

   2. Communicate Any Issues:

      • Notify the Clinic immediately of any side effects, discomfort, or concerns.

   3. Acknowledge the Role of Compliance:

      • The success of the program depends on the Patient’s full participation and adherence to instructions. Failure to follow instructions, attend appointments, or report on diet and exercise compliance will void any guarantee.

4. Refund and Payment Terms

Payment Policy:

1. Non-Refundable Fees:

   • All program fees are non-refundable except under health-related circumstances approved by the Clinic.

2. Payment Plan Commitment:

   • Patients enrolled in a payment plan must complete all payments, even if they choose to discontinue the program.

Refunds for Health Issues:

• If the program is stopped due to a health issue (verified by a licensed medical professional), a pro-rated refund will be issued based on the unused treatments. Past treatments already provided are non-refundable.

Guarantee Policy:

1. Results Guarantee:

   • If the Patient adheres to all instructions (diet, exercise, appointments) and the program does not achieve the agreed-upon goals, the Clinic will provide an additional 4 weeks of complimentary treatments.

   • If the goal is still unmet after the complimentary period, a full refund will be issued.

2. No Guarantee Without Compliance:

   • If the Patient fails to follow instructions, skip appointments, or opt out of certain treatments, the Clinic cannot guarantee results, and no refunds will be provided.

5. Important Disclaimers

1. No Medical Treatment:

   • This program is exclusively for weight loss purposes. Treatments, medications, and injections are not intended to diagnose, manage, or treat any medical conditions.

   • The Patient must consult their primary care provider for medical concerns unrelated to weight loss.

2. Treatment Variability:

   • The Clinic customizes treatments based on individual needs, and certain treatments may be omitted or adjusted based on the doctor’s recommendations.

   • Results may vary depending on individual factors such as body chemistry, lifestyle adherence, and health status.

6. Acknowledgment

By signing this Agreement, the Patient confirms that:

1. They have read and understood the terms, potential side effects, and refund policies.

2. They accept the risks and responsibilities associated with the program.

3. They agree to comply with the program instructions and policies.