Vitamin Booster Consent

Vitamin Injections Consent:

An intramuscular injection is a technique used to deliver a medication deep into the muscles. This allows the medication to be absorbed into the bloodstream quickly. 

Vitamin Injections common side effects include but are not limited to:

Mild diarrhea, upset stomach, nausea, a feeling of pain and a warm sensation at the site of the injection, a feeling, or a sense, of being swollen over the entire body, headache and joint pain.

If any of these side effects become severe or troublesome I will contact my physician immediately.

I understand that although rare Vitamin injections can result in serious side effects. Although this is a relatively rare occurrence, anyone taking Vitamin injections should be aware of the possibility.

Uncommon side effects are much more serious than the common side effects of Vitamin injections, and such side effects should be reported to a physician to be evaluated for seriousness.

Uncommon and dangerous side effects include:

• headache
• nausea
• diarrhea
• bloating
• constipation
• indigestion or heartburn
• abnormal bleeding
• gastrointestinal hyperactivity
• chest pain
• flushed face
• chills
• fever
• upset stomach
• kidney stones
• fingernail weakening
• hair loss
• rapid heartbeat
• heart palpitations
• restlessness
• muscle cramps and weakness
• dizziness

I understand the possibility of having an allergic reaction to any of the ingredients found within the Vitamin injection is quite plausible and that I should communicate with my Physician if I have any known allergic reactions to foods, dyes, preservatives, or any other substances. If I experience any of these following signs of allergic reactions I should immediately consult my primary health care Physician and discontinue further use of the product.

Signs of allergic reactions include, but not limited to:
• Itching of skin
• Hives
• Rashes
• Wheezing
• Difficulty breathing
• Swelling of mouth or throat

When medications are taken in conjunction with the Vitamin Injection, drug interactions could occur. These interactions can either increase your risk of bleeding or block the absorption of the Vitamins into the body. These medications at the time of your injection should either be discontinued or be consulted with by a Physician.

Some of the medications that may cause drug interactions include, but are not limited to:

  • • Heparin (Fragmin, Lovenox, Innohep…ect.)
    • Antithrombin (A Tryn, Thrombate III)
    • Argatroban
    • Aspirin
    • Ibuprofen
    • Dipyridamole (Persantine)
    • Bivalirudin (Angiomax)
    • Clopidogrel (Plavix) • Warfarin (Coumadin, Jantoven)
    • Nonsteroidal anti-inflammatory drugs (Ibuprofen,…etc.)

Before starting the Vitamin injections I will make sure to tell my Physician if I am pregnant, lactating or have any of the following conditions.

  • • Leber’s Disease
    • Kidney disease
    • History of Kidney stones
    • Liver disease
    • Hormonal disease
    • Cardiovascular disease
    • History of ulcers
    • History of gastrointestinal problems
    • Bipolar disorder (manic depression)
    • Attention Deficit Hyperactivity Disorder (ADHD)
    • Muscular Dystrophy
    • Elliptic seizures
    • Hypoglycemia
    • Schizophrenia
    • Benign prostatic hypertrophy (BPH)
    • Acetaminophen poisoning
    • Hypertension (high blood pressure)
    • History of seizures
    • Under-active thyroid (hypothyroidism)
    • Osteoporosis
    • Receiving treatment or taking any medication that might “thin” the blood
    • Receiving treatment or taking medication that has an effect on bone marrow
    • An infection
    • Iron deficiency
    • Folic acid deficiency
    • Dependent on intravenous nutrition (TPN) or liquid nutrition products for food
    • Diabetes, mellitus, or high blood sugar levels
    • An unusual or allergic reaction other medicines, foods, dyes, or preservatives

I understand that certain herbal products, vitamins, minerals, nutritional supplements, prescription and non prescription medications may result in side effects when they interact with the Vitamin Injection.

Bruising at the Injection Point:
It is important to know bruising at the injection point can happen.

-Apply a cold compress to the bruise, but be sure to not press down hard
-Apply Arnica Gel
-Be Patient, the bruise will go

-Massage the area, this will cause the bruise to spread

I understand that the treatment may involve risks of complication or injury from both known and unknown causes, and I freely assume those risks. Prior to receiving treatment, I have been candid in revealing any condition that may have a bearing on this procedure.

I consent and authorise Paige Edmonds to perform one or more Vitamin Booster treatments on me. I certify that I have read this entire informed consent and I understand and agree to the information provided in the form. My questions regarding the procedure have been answered satisfactorily.

I hereby release Paige Edmonds from all liabilities associated with this procedure. This consent is valid for all of my Vitamin Booster treatments in the future as well.