MEDICAL WEIGHT MANAGEMENT PROGRAM Patient Information, Safety, and Informed Consent

Medical Weight Management Program

A physician-supervised clinical weight management option for eligible adults, delivered with strict medical, ethical, and legal standards in the state of California.

Slimshot is not a fad program or cosmetic shortcut. It is a structured medical treatment pathway that may include GLP-1–based or other FDA-approved therapies when appropriate, combined with professional oversight, risk screening, and lifestyle guidance.

What is Slimshot?

Slimshot is a physician-directed weight management program for adults who medically qualify under evidence-based criteria for pharmacologic weight management.

Under this program, the supervising physician may prescribe FDA-approved medications for weight management or metabolic disease (including GLP-1 receptor agonists such as semaglutide or similar agents), only after a clinically appropriate evaluation and in accordance with FDA labeling, federal law, and California Medical Board standards.

Slimshot includes:

Medical intake and history review
BMI and risk factor assessment
Medication eligibility and contraindication review
Individualized dosing and monitoring
Lifestyle and behavioral recommendations where appropriate
Scheduled follow-up and treatment adjustments

Enrollment is never automatic or guaranteed.

Eligibility and Safety

Who is typically eligible?

Eligibility is determined by the physician, generally consistent with:

BMI ≥ 30, or
BMI ≥ 27 with at least one related condition such as hypertension, type 2 diabetes, dyslipidemia, or sleep apnea.

Final approval depends on full review of your history, labs, risks, and benefit profile.

Who is not a candidate?

Patients may be declined or discontinued if they have or develop:

Personal or family history of medullary thyroid carcinoma (MTC) or MEN 2
Prior serious hypersensitivity to GLP-1 or related medications
History of pancreatitis or unexplained severe abdominal pain
Severe gastrointestinal disease (e.g., severe gastroparesis)
Certain significant renal, hepatic, or endocrine disorders
Pregnancy, plans for pregnancy, or breastfeeding
Inability or unwillingness to comply with monitoring, labs, or follow-up

The physician may deny, delay, or discontinue therapy at any time if medically indicated or required for safety.

Treatment, Risks, and Monitoring

How does Slimshot work?

Where GLP-1 or similar agents are prescribed, they act on metabolic and appetite pathways to support clinically meaningful weight reduction and improved glycemic control. These medications are used as part of a broader treatment plan and must be taken exactly as prescribed.

What are the primary risks and side effects?

Potential side effects (not exhaustive) include:

Nausea, vomiting, diarrhea, constipation, abdominal pain
Headache, fatigue, indigestion
Possible gallstones or gallbladder inflammation
Risk of pancreatitis
Possible worsening of kidney function, especially with dehydration
Possible increase in heart rate
Injection site reactions
Rare but serious allergic reactions (including anaphylaxis, angioedema)
Boxed warning for risk of thyroid C-cell tumors in rodent studies; contraindicated with MTC/MEN 2

Any severe, persistent, or concerning symptom requires immediate medical attention. Patients are instructed to contact the clinic or emergency services per the Informed Consent section.

Is Slimshot safe during pregnancy or breastfeeding?

No. Medication-based weight management is contraindicated during pregnancy and generally not recommended during breastfeeding. Patients must report pregnancy or intent to conceive immediately so therapy can be reassessed and discontinued where required.

Are results guaranteed?

No. Individual responses vary. No specific amount or rate of weight loss is guaranteed. Statements regarding outcomes are educational, not contractual.

What monitoring is required?

Patients may be required to complete:

Baseline labs (e.g., CMP, kidney and liver function, lipids, HbA1c/glucose, pregnancy test as indicated)
Periodic labs and vitals
Scheduled follow-up visits (telehealth or in-person)
Symptom and side effect reporting

Failure to comply may result in suspension or termination of treatment.

Privacy, Communications, and SMS Policy

How is my data protected?

Pure Forme Collective maintains safeguards consistent with HIPAA Privacy and Security Rules and applicable California privacy law, using secure systems for PHI where feasible.

PHI is collected and used only for treatment, operations, payment, or as required by law.
Electronic systems are configured to protect confidentiality, integrity, and availability of PHI.
Your detailed rights and the clinic’s obligations are defined in the full Privacy Policy and Notice of Privacy Practices posted on the site.

How do SMS, email, and portal messaging work?

By opting in:

You agree to receive appointment reminders, important treatment notices, and limited service-related updates.
Promotional or non-essential messages are optional and may be opted out at any time.
Clinical details are preferably communicated through secure systems; if you choose standard SMS/email, you acknowledge residual privacy risk.
Messaging is not for emergencies or crisis situations.

Payment, Auto-Pay, and Refunds

Slimshot services or membership fees may be self-pay and billed in advance or on a recurring schedule as disclosed at time of enrollment.
Patients are responsible for verifying their own insurance coverage; out-of-network or non-covered services remain the patient’s responsibility.
Due to the professional nature of medical services and administrative costs, fees for completed consultations, clinical services, or dispensed medications are generally non-refundable, consistent with posted policies and applicable law.
Any recurring payment (e.g., multi-week program) clearly states:
- Amount
- Frequency
- Duration
- How to cancel future, not-yet-rendered services within policy boundaries.

Patient Responsibilities

Patients participating in Slimshot agree to:

Provide full and accurate medical history and medication list.
Disclose all relevant conditions including thyroid disease, cancers, pancreatitis, gallbladder issues, kidney disease, pregnancy, and mental health conditions where relevant.
Follow dosing instructions precisely.
Immediately report serious or unexpected symptoms.
Complete labs and follow-up visits as instructed.
Use the medication only as prescribed and never share with others.
Review and agree to the Terms of Service, Privacy Policy, and this Informed Consent before starting therapy.

Non-compliance may result in modification, pause, or termination of treatment.

Informed Consent for Slimshot / GLP-1 Therapy

1. Nature and Purpose of Treatment

I understand that Slimshot is a medically supervised weight management program that may include the prescription of FDA-approved or clinically accepted medications for weight management and related metabolic conditions, including GLP-1 receptor agonists and similar agents, when appropriate.

I understand that the goal of treatment is to assist with clinically significant, sustainable weight reduction and improvement of obesity-related health risks. I understand Slimshot is not a cosmetic or “quick fix” service.

2. Evaluation and Eligibility

I understand that treatment will only be initiated after a licensed clinician has:

Reviewed my medical history, medications, and allergies.
Determined that I am an appropriate candidate based on established clinical criteria.
Ruled out known contraindications to the proposed medication(s).

I understand that the clinician may decline, modify, or discontinue treatment if risks outweigh benefits or if I do not comply with program requirements.

3. Potential Benefits

I understand that potential benefits may include weight loss, improved metabolic markers, and reduction in certain obesity-related risks. I acknowledge that no specific result, amount of weight loss, or health improvement is guaranteed.

4. Risks, Side Effects, and Warnings

I acknowledge that I have been informed, in clear language, of the potential risks and side effects associated with GLP-1–based and similar therapies, which may include but are not limited to:

Nausea, vomiting, diarrhea, constipation, abdominal discomfort
Headache, fatigue, dizziness
Gallstones or gallbladder disease
Risk of pancreatitis
Changes in kidney function
Increased heart rate
Injection site or allergic reactions, including rare severe reactions
Risk of thyroid C-cell tumors observed in animal studies; contraindication if I or my family have a history of medullary thyroid carcinoma (MTC) or MEN 2 as reflected in FDA boxed warnings.

I agree to immediately notify the clinic or seek emergency care if I experience:

Severe or persistent abdominal pain (with or without vomiting)
Neck mass, difficulty swallowing, hoarseness, or trouble breathing
Signs of allergic reaction such as rash, swelling, or trouble breathing
Significant decrease in urination or swelling suggesting kidney problems
Any other severe, unusual, or rapidly worsening symptoms

5. Alternatives

I understand that alternatives to Slimshot include lifestyle-only interventions, nutrition counseling, behavioral therapy, other pharmacologic options where appropriate, or bariatric surgery where clinically indicated. I have the right to decline medication-based treatment.

6. Off-Label Use (If Applicable)

I understand that if the clinician prescribes any medication or dosage outside of FDA-labeled indications, this will be based on evidence-informed clinical judgment. I will have an opportunity to ask questions before agreeing.

7. Telehealth and Remote Care

If telehealth is used:

I consent to receive medical services via telemedicine in compliance with California law and Medical Board standards, including documentation of this consent in my medical record.
I understand telehealth has inherent limitations and that in-person evaluation or testing may be required.
I agree that prescriptions will not be issued without an appropriate evaluation and established physician-patient relationship.

8. Privacy, Data Use, and Communications

I acknowledge:

My health information will be handled in accordance with the clinic’s Privacy Policy and applicable HIPAA rules.
Email, SMS, or similar channels may carry some residual privacy risk. When I opt in, I authorize the clinic to contact me using those methods for appointment reminders, care coordination, and limited program information.
I may opt out of non-essential promotional messages at any time, but certain clinical or transactional communications may still be required.

9. Financial Responsibility

I understand:

I am responsible for all fees associated with Slimshot services, whether or not my insurance provides coverage.
Fees, auto-pay terms, program duration, and cancellation rules are outlined in the clinic’s financial policies and Terms of Service.
In general, charges for completed professional services, consultations, or dispensed medications are not refundable, except where required by law or explicit policy.

10. Patient Obligations

By consenting, I agree to:

Provide accurate and complete information.
Inform my provider promptly of pregnancy, planned pregnancy, breastfeeding, major new diagnoses, or hospitalizations.
Follow dosing and safety instructions.
Complete lab tests and follow-up visits as directed.
Not share my medication with anyone.

Failure to do so may result in change or termination of my treatment plan.

11. No Guarantee and No Emergency Care

I understand:

No guarantee has been made regarding results.
This program does not replace primary or emergency care.
In an emergency (chest pain, severe shortness of breath, signs of stroke, severe reaction, etc.) I must call 911 or go to the nearest emergency department and not rely on messaging systems.

12. Acknowledgment and Consent

“I have read and understand the Slimshot Program FAQ and this Informed Consent. I have had the opportunity to ask questions and all my questions were answered to my satisfaction. I understand the risks, benefits, and alternatives and voluntarily consent to evaluation and, if I am found eligible, to participate in the Slimshot medical weight management program under the care of the designated clinician(s). I understand this consent will remain in effect unless and until revoked in writing, except where treatment already rendered or legal obligations require otherwise.”

[ ] I Agree and Consent to Treatment
[ ] I Acknowledge Receipt of the Terms of Service and Privacy Policy
[ ] I Consent to Electronic Communications as Described

Slimshot is a physician-supervised medical program. Information on this page is for educational purposes and does not replace an in-person evaluation or individualized medical advice. Treatment is provided only after a licensed clinician determines medical eligibility. If you are experiencing a medical emergency, call 911 or go to the nearest emergency department immediately.

MEDICAL WEIGHT MANAGEMENT PROGRAM Patient Information, Safety, and Informed Consent