• Peptide therapy for the purpose of preventative care, weight loss, performance enhancement, anti-aging, and any additional condition discussed by Amber Tomse, APRN is considered by the FDA to be “off-label use.”
• Peptide therapy can be administered either orally, subcutaneously, intramuscularly, intravenously, or intranasally. The various preparations will be discussed with me by Amber Tomse, APRN.
• Peptide therapies being administered by Amber Tomse, APRN D.B.A. Beauty Refined, LLC are prepared by registered compounding pharmacies that comply with all state and federal regulations.
• I acknowledge that Amber Tomse, APRN D.B.A. Beauty Refined, LLC is not be responsible for any manufacturing issues related to peptides prepared by compounding pharmacies and that the sole responsibility for sterility, potency, and safety lie with these pharmacies.
• I understand that peptide therapies are not necessarily approved for my medical conditions and they are not a medical necessity, rather, they are an adjunctive and complimentary therapy to my treatment plan. Therefore, I acknowledge that it is an elective treatment option.
• (WOMEN ONLY) There has been little research regarding the safety of peptide therapy in pregnant and breast-feeding women. I certify that I am not pregnant nor plan on becoming pregnant while on peptide therapy.
• I understand that with any drug, peptide therapies can carry potential side effects, including but not limited to:
• Rash, fever, nausea, vomiting, allergic reactions, decreased insulin sensitivity, flushing, headache, fatigue, lightheadedness, abdominal cramping, joint pain, fluid retention, and additional side effects not listed that will be discussed during your evaluation with Amber Tomse, APRN/Beauty Refined, LLC
• I understand that alternatives to peptide therapy are:

– Doing nothing

– FDA approved standard medication treatments

– Referral to specialists.

– Surgery

• I acknowledge that there are no guarantees relating to the efficacy of peptide therapies and that Amber Tomse, APRN D.B.A. Beauty Refined, LLC are not responsible for my individual performance and ability to also exercise and diet.
• I certify that I will notify Amber Tomse, APRN D.B.A. Beauty Refined, LLC immediately if I have any concerns or side effects.
• I certify that I have had the risks and benefits discussed with me about peptide therapy and that I have had all my questions and concerns answered to my satisfaction by Amber Tomse, APRN D.B.A. Beauty Refined, LLC
• I hereby voluntarily consent to be evaluated and treated by Amber Tomse, APRN D.B.A. Beauty Refined, LLC with the goal of improving my health, performance, and possibly delaying the effects of aging through peptide therapies.
• By making this purchase, Beauty Refined is not responsible for any lost or stolen packages.
• All sales final, no refunds