I voluntarily consent to participate in the Qlinicare Medical Weight Loss Program.
I understand that this program may include:
* Nutritional guidance
* Lifestyle and behavioral counseling
* Physical activity recommendations
* Prescription medications, including but not limited to GLP-1 receptor agonists and/or appetite suppressants

MEDICATION RISKS

I understand that medications used for weight loss may have potential side effects, including but not limited to:
* Nausea, vomiting, or diarrhea
* Constipation
* Headache or dizziness
* Changes in blood sugar levels
* Possible cardiovascular or gastrointestinal effects
I understand that rare but serious side effects may occur and that I should report any concerning symptoms immediately.

NO GUARANTEED RESULTS

I understand that:
* Weight loss results vary from person to person
* No specific outcome or amount of weight loss is guaranteed
* Results depend on adherence to the program, lifestyle changes, and individual health factors

LIFESTYLE RESPONSIBILITY

I acknowledge that successful weight loss requires my active participation, including:
* Following dietary recommendations
* Engaging in regular physical activity
* Attending follow-up visits as recommended
* Taking medications as prescribed

MEDICATION USE

I agree to:
* Use medications only as prescribed
* Not share medications with others
* Inform my provider of all medications and supplements I am taking

MEDICAL DISCLOSURE

I certify that I have provided complete and accurate medical history information, including:
* Current medications
* Medical conditions
* Allergies
I understand that failure to provide accurate information may affect my safety and treatment outcomes.

RIGHT TO WITHDRAW

I understand that I may withdraw from the program at any time, and that QliniCare reserves the right to discontinue treatment if medically necessary or if program guidelines are not followed.

CONSENT

I have read and understand the information above. I have had the opportunity to ask questions and agree to participate in the Qlinicare Weight Loss Program.