Peptide Therapy Informed Consent

Last Updated: May 1, 2025

By completing the Health History & Consent form and utilizing LOGiC Health's services, you acknowledge that you have read, understood, and agree to the following Peptide Therapy Informed Consent. This consent outlines the policies governing our telehealth services and defines the scope of the patient-provider relationship as it pertains to peptide therapy.

Purpose of Peptide Therapy

Peptide therapy involves the use of short chains of amino acids designed to signal, mimic, and regulate various physiological functions in the body. These therapies may be prescribed to support targeted health goals under the guidance of our licensed providers.

Potential Benefits

Potential benefits of prescribed peptide therapy may include, but are not limited to:

• Improved recovery, healing, repair, muscle growth, and metabolic function
• Enhanced metabolism or fat loss
• Improved sleep quality, skin elasticity, joint health, tissue repair, or cognitive function
• Increased energy and mental clarity
• Support for immune function, reduction in oxidative stress, hormonal balance, and age-related decline

Results vary from person to person, and no outcomes are guaranteed.

Possible Risks and Side Effects

While generally well-tolerated, peptide therapy can carry potential risks and side effects, including but not limited to:

• Redness, swelling, bruising, irritation, or pain at the injection site
• Allergic reaction, hypersensitivity, or antibody formation
• Headache, fatigue, dizziness, or nausea
• Water retention or swelling
• Hormonal fluctuations
• Changes in appetite or mood
• Unknown long-term effects, as many peptides are not FDA approved for specific medical indications

Specific Cancer Risk

Some peptides, such as growth hormone-releasing peptides like CJC-1295 or Ipamorelin, may theoretically increase cancer risk due to elevated IGF-1 levels, which can promote cell growth. Key considerations include:

• Peptides should not be used by patients with active cancer or a history of cancer.
• If you have a family history of cancer or other risk factors, discuss these with your healthcare provider before starting therapy.
• Your healthcare provider will monitor your health to mitigate risks, but no treatment can eliminate the possibility of adverse outcomes.
• Long-term safety data on many peptides is limited, and the full extent of cancer risk is not fully understood.

If you experience any severe or concerning symptoms, discontinue use and notify your healthcare provider immediately.

Contraindications

Peptide injections may be contraindicated in the following situations:

• Active or past history of cancer
• Pregnancy or breastfeeding
• Severe liver or kidney impairment
• Known allergies to peptide components
• Bleeding disorders or cardiovascular conditions

Inform your healthcare provider of your full medical history, including any current or past conditions, medications, or supplements, to assess suitability for peptide therapy.

Treatment Protocol

LOGiC Health's licensed providers will develop a personalized treatment protocol based on your health history, goals, and laboratory data. Dosages, frequency, and duration of therapy will be tailored to your needs and may be adjusted over time. You agree to follow the prescribed protocol and attend all recommended follow-up appointments to ensure safe and effective treatment.

Patient Rights and Responsibilities

Your Rights: You have the right to:

• Receive quality care regardless of the delivery method
• Confidentiality of your medical information in accordance with HIPAA
• Access your medical records
• Have the opportunity to discuss risks, benefits, and alternatives with your provider

Your Responsibilities: You agree to:

• Provide accurate and complete health information
• Be located in a state where our providers are licensed during consultations
• Ensure you have the necessary technology and internet connection for telehealth visits
• Inform all healthcare providers of your peptide therapy to avoid interactions with other treatments
• Understand that results are not guaranteed and therapy may not achieve desired outcomes

Peptide Therapy Consent

I have read and understood the information provided in this document. I understand I will have the opportunity to discuss the risks, benefits, alternatives, and protocols with my healthcare provider and have all my questions answered to my satisfaction. I understand the purpose of peptide therapy and acknowledge that it carries potential benefits and possible risks. I recognize that many peptides are not FDA approved for the specific uses for which they may be prescribed. I understand that results are not guaranteed and that I may choose to stop therapy at any time. I accept that unforeseen complications may occur and agree to inform my healthcare provider of any adverse reactions or health changes.

Acknowledgment and Agreement

By checking the consent box on the Health History & Consent form and providing your electronic signature, you acknowledge that you have read, understood, and agree to this Peptide Therapy Informed Consent. You voluntarily consent to proceed with peptide therapy as prescribed under the care of LOGiC Health's licensed providers and agree to adhere to the treatment plan.