Reset Wellness, PLLC Policies

Before beginning treatment, my provider will explain the proposed treatment, its expected benefits, material risks and side effects, and reasonable alternatives, including choosing not to receive treatment. I will have an opportunity to ask questions and receive answers before deciding whether to proceed.

I understand that individual responses vary and that no specific outcome, amount of weight loss, or absence of side effects is guaranteed. Medication-specific risks and instructions will be provided separately.

I agree to provide accurate and complete information about my health history, medications, supplements, allergies, and other relevant circumstances. I will notify my provider of changes, follow prescribing instructions, and complete recommended follow-up visits and testing. I will contact Reset Wellness promptly about side effects, dosing questions, or treatment concerns. For a medical emergency, I will call 911 or seek emergency care.

Reset Wellness provides specialized care and does not replace my primary care provider or other necessary medical services. I am encouraged to coordinate my care with my other treating professionals.

I may decline treatment or withdraw my consent to future treatment at any time. My provider may modify, pause, or discontinue treatment when clinically appropriate and discuss appropriate next steps with me.

Acknowledging treatment risks does not waive my legal rights, release the clinic or its providers from responsibility for negligent or unlawful care, or limit my right to raise concerns, file a complaint, or seek remedies available under applicable law.

Services must be paid for before the time of service.

Please also note that we do not automatically ship medication without a visit. Medication is ordered during visits when requested and needed.

Health insurance typically does not cover services provided at Reset Wellness, PLLC. If you want to seek insurance reimbursement, we would be happy to provide you itemized invoices that you can submit to your insurance company.

Purpose and treatment options

I am considering injectable semaglutide or tirzepatide for weight management. Semaglutide acts on GLP-1 receptors; tirzepatide acts on GIP and GLP-1 receptors. My provider will explain the recommended medication, potential benefits, risks, and alternatives, including FDA-approved medications, lifestyle treatment, other appropriate interventions, or no medication.

Treatment is based on my medical evaluation and is not guaranteed. Individual responses vary, and weight regain may occur after stopping treatment.

Common and serious risks

Common side effects include nausea, vomiting, diarrhea, constipation, abdominal discomfort, reflux, and fatigue. Symptoms can sometimes be severe.

Important risks include pancreatitis, gallbladder disease, dehydration and kidney injury, serious allergic reactions, and severe gastrointestinal problems. These medications slow stomach emptying and are not recommended for patients with severe gastroparesis. Low blood sugar can occur, particularly when used with insulin or certain diabetes medications. Semaglutide may worsen diabetic retinopathy in some patients and may increase heart rate.

Approved semaglutide and tirzepatide products carry a boxed warning about thyroid C-cell tumors observed in rodents. Whether this risk occurs in humans is unknown. I must not use these medications if I have a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2, or a prior serious allergic reaction to the prescribed medication or its ingredients.

I will disclose all medical conditions, medications, supplements, allergies, and any history of pancreatitis, gallbladder disease, significant digestive problems, kidney disease, or diabetic eye disease.

Pregnancy, contraception, and procedures

These medications are not used for weight loss during pregnancy. If I become pregnant, I will stop treatment and contact my provider promptly. I will discuss pregnancy plans and breastfeeding before treatment. Semaglutide should be stopped at least two months before a planned pregnancy.

Tirzepatide may reduce the effectiveness of oral hormonal contraceptives. If applicable, I will use a non-oral contraceptive method or add a barrier method for four weeks after starting tirzepatide and four weeks after each dose increase.

I will tell my anesthesia and procedure teams that I take this medication because delayed stomach emptying may increase aspiration risk during general anesthesia or deep sedation.

Dosing and follow-up

I will follow my individualized prescription and will not independently increase doses or combine this medication with another GLP-1 medication or another product containing the same active ingredient.

For a vial, I will confirm the prescribed dose in milligrams and the corresponding volume or syringe units. Concentrations may change between prescriptions. If instructions are unclear, I will contact the clinic or pharmacy before injecting. I will follow storage and discard instructions and complete required follow-up visits and testing.

If a compounded formulation is prescribed

Compounded medications are not FDA-approved. FDA does not review them for safety, effectiveness, or quality before marketing. They are not FDA-approved generic versions of brand-name medications.

My provider will explain why a compounded formulation is being considered for my individual medical needs, discuss available FDA-approved alternatives, and identify any additional ingredients and their relevant risks. Compounded prescribing and dispensing must meet applicable legal requirements.

When to seek help

I will promptly report persistent vomiting, inability to maintain hydration, new vision changes, or other concerning symptoms. Severe or persistent abdominal pain requires urgent medical evaluation. Trouble breathing, facial or throat swelling, fainting, or other emergency symptoms require immediate emergency care.

Voluntary consent

Before starting treatment, I will have an opportunity to discuss medication-specific risks and ask questions. My decision is voluntary, and I may decline or withdraw consent to future treatment. Signing this consent does not waive my legal rights or my right to raise concerns or file complaints.

Medication/formulation prescribed: ____________________

Patient name: ____________________

Patient signature and date: ____________________

Provider name and date of consent discussion: ____________________

Please read each section carefully. You may request a copy of this form for your own records.

Introduction: Telemedicine involves the real-time evaluation, diagnosis, consultation on and treatment of a health condition using advanced telecommunications technology, which may include the use of interactive audio, video or other electronic media. As such, telemedicine allows the provider to see and communicate with the patient in real time. There are potential risks to this technology, including interruptions, unauthorized access and technical difficulties. I understand I can ask questions and seek clarification of the procedures and telemedicine technology at any time.

Consent for treatment: I voluntarily request Reset Wellness, PLLC and its nurse practitioners, nurses, associates, technical assistants and other health care providers as it may deem necessary (collectively "Practice") to participate in my medical care through the use of telemedicine.

I understand that Practice (i) may practice in a different location than where I present for medical care, (ii) may not have the opportunity to perform an in-person physical examination, and (iii) relies on information provided by me. I acknowledge that it is my responsibility to provide information about my medical history, condition and care that is complete and accurate to the best of my ability. I further acknowledge my failure to accurately and completely relay information about my medical history, condition and care may adversely impact Practice's advice, recommendations, or decisions about my care. I understand that the practice of medicine is not an exact science and that no warranties or guarantees are made to me as to result or cure.

I understand that if Practice determines in its reasonable professional judgment that telemedicine services will not adequately address my medical needs, I may be required to complete an in-person medical evaluation. I also understand that in the event the telemedicine session is interrupted due to a technological problem or equipment failure, alternative means of communication may be implemented, or an in-person medical evaluation may be necessary. Finally, if I experience an urgent matter after a telemedicine session, such as a bad reaction to a treatment, I should alert my treating physician and, in the case of emergencies, dial 911 or go to the nearest hospital emergency department.

Right to withdraw consent: I understand that I have the right to withdraw my consent to the use of telemedicine in the course of my care at any time.

I have read this Telemedicine Consent in its entirety and agree to be bound by all of its terms and conditions as described above. I acknowledge and agree that I have been given the opportunity to ask any questions and have either (i) declined the opportunity to do so, or (ii) had all my questions answered to my satisfaction.

Questions about these policies? Email us at Orders@RW-Clinic.com or call 888-311-9776.