Medical Consent
Last updated: May 1, 2026
Informed Consent for GLP-1 Medication
By completing the Novolene evaluation and proceeding with treatment, you acknowledge and consent to the following:
Treatment Description
You are seeking treatment with compounded GLP-1 receptor agonist medication (semaglutide or tirzepatide) for weight management. These medications are not FDA-approved in compounded form but contain the same active ingredients as brand-name medications Ozempic/Wegovy (semaglutide) and Mounjaro/Zepbound (tirzepatide).
Risks and Side Effects
Potential side effects include but are not limited to:
- Nausea, vomiting, diarrhea, or constipation
- Injection site reactions (redness, swelling)
- Headache or fatigue
- Possible thyroid tumors (based on animal studies; risk in humans is not established)
- Pancreatitis (rare but serious)
- Gallbladder issues
- Hypoglycemia (low blood sugar), especially when combined with other diabetes medications
Compounded Medication Acknowledgment
You understand that compounded medications are prepared by FDA-regulated compounding pharmacies and are not FDA-approved. Compounded medications may differ from brand-name versions in inactive ingredients. The decision to use compounded medication is made by your licensed provider based on your medical history.
Provider Authorization
You authorize the Novolene medical provider team to review your medical history, evaluate your eligibility for treatment, and prescribe medication if clinically appropriate. You understand that a prescription is not guaranteed and is at the sole discretion of the licensed provider.
Responsibilities
You agree to:
- Provide accurate and complete medical information
- Inform your provider of any changes in health status, medications, or side effects
- Follow dosing instructions provided by your prescriber
- Seek emergency care if you experience severe side effects
Contact
For medical questions or concerns, contact your Novolene provider team at support@novolene.com or (213) 436-1474. For emergencies, call 911.