Medical Weight Loss,
Backed by Science

Informed Consent for GLP-1 Medical Weight Management

This document confirms your understanding of and voluntary agreement to receive GLP-1 receptor agonist therapy (Semaglutide or Tirzepatide) through Sonali Health PLLC, a Texas-licensed telemedicine practice.

Nature of Treatment

GLP-1 receptor agonists are injectable medications that work by mimicking the action of the glucagon-like peptide-1 hormone to reduce appetite, slow gastric emptying, and improve blood sugar regulation. They are used in conjunction with dietary changes and physical activity for medical weight management.

Benefits

• Clinically significant weight reduction (avg 15–22% of body weight in trials)
• Improvement in blood sugar, blood pressure, and cholesterol
• Reduced risk of cardiovascular events in certain populations
• Improved energy, mobility, and quality of life

Risks and Side Effects

• Common: Nausea, vomiting, diarrhea, constipation, decreased appetite, injection site reactions
• Less Common: Pancreatitis, gallbladder disease, hypoglycemia (especially with concurrent diabetes medications)
• Rare but Serious: Medullary thyroid carcinoma (contraindicated in personal/family history of MTC or MEN2)
• This medication is contraindicated during pregnancy

Telehealth Delivery

Your consultation will be conducted via HIPAA-compliant video. All communication, prescription management, and follow-up will occur through the Sonali Health telemedicine platform. You understand this is not a substitute for emergency care.

Patient Responsibilities

• Disclose all medications, supplements, and medical conditions accurately
• Report adverse effects promptly to your provider
• Attend scheduled follow-up consultations
• Seek emergency care immediately if you experience severe abdominal pain, difficulty breathing, or signs of a serious allergic reaction

Medication Costs

Consultation fees are separate from medication costs. Prescriptions will be sent to your preferred compounding or retail pharmacy. Medication pricing varies and is the patient's financial responsibility.

Privacy

Your health information is protected under HIPAA. Sonali Health PLLC will not share your information without your written consent except as required by law.

Voluntary Participation

You may withdraw from this program at any time without penalty. Discontinuation should be discussed with your provider to ensure safe tapering if clinically appropriate.