I understand that in order to qualify for initial treatment I must be at least 18 years of age and have a BMI of at least 25. All treatments will be discontinued at BMI of 20. I understand that this is compounded medication and may contain B12, Zofran, or other nutrient additives. I will discuss any medication allergies with my prescribing provider. I understand that current pregnancy or breastfeeding, a history of thyroid cancer, kidney disease, and some gastrointestinal conditions like gastroparesis, pancreatitis of unknown origin, and IBD are contraindications for treatment. I understand that if I don't qualify, I will be refunded the amount paid minus $30 for the provider consult.

I understand that this is a recurring monthly subscription and my card will be charged the same fee every month. I may cancel at any time by emailing [email protected].

DO NOT SUBMIT THIS ORDER IF YOU ARE CURRENTLY BREASTFEEDING, HAVE A HISTORY OF THYROID CANCER, KIDNEY DISEASE, OR HAVE A HISTORY OF GASTROPARESIS, PANCREATITIS OF UNKNOWN ORIGIN, OR IBD.