Vitamin injections maintain good health and have been shown to be beneficial in helping to: Reduce stress, fatigue, improve memory and cardiovascular health, and maintain a good body weight. It can also assist the body in converting proteins, fats and carbohydrates into energy and is necessary for healthy skin and eyes. Vitamin injections are better absorbed by the body since they go directly into the blood stream. Alternatives to vitamin injections are oral vitamins, patch, lozenges, liquid drops, and nasal spray.

1. Risks: I understand there is a risk of mild diarrhea, upset stomach, nausea, a feeling of pain and a warm sensation at the site of the injection, a feeling, or a sense, of being swollen over the entire body, headache and joint pain.

2. If any of these side effects become severe or troublesome, I will contact my Provider immediately.

3. I understand that although rare, vitamin injections can result in serious side effects. Although this is relatively rare occurrence, anyone taking vitamin injections should be aware of the possibility. Uncommon side effects include: ∙ rapid heartbeat ∙ chest pain ∙ flushed face ∙ muscle cramps and weakness ∙ difficulty breathing and swallowing ∙ dizziness ∙ confusion ∙ tight feelings in the chest ∙ hives, skin rashes ∙ shortness of breath when there is no physical exertion and unusual wheezing, and ∙ coughing. 

4. Before starting Vitamin injections, I will make sure to tell my Provider or contact the clinic. if I am pregnant, lactating, or have any of the following conditions ∙ Leber’s disease ∙ Kidney disease ∙ Liver disease ∙ An infection ∙ Iron deficiency ∙ Folic acid deficiency ∙ Receiving any treatment that has an effect on bone marrow ∙ Taking any medication that has an effect on bone marrow ∙ An allergy to cobalt or any other medication, vitamin, dye, food or preservative. 

5. I understand that certain herbal products, vitamins, minerals, nutritional supplements, prescription and non-prescription medications may result in side effects when the interact with the vitamin injection. 

6. I understand that I will be receiving a B6/B12 vitamin injection or a Vitamin and Amino Acid injection consisting of Vitamin B6/B12, methionine, inosital, and choline. 

This injection is commonly referred to as a lipotropic injection “skinny shot” or a MIC-B12 “fat burner” injection. 

By signing below, I acknowledge that I have read the foregoing informed consent and agree to the Vitamin treatment with its associated risks. I hereby give consent to perform this and all subsequent injections with the above understood. I hereby release the Provider, the person injecting the vitamins, and the facility from liability associated with this procedure.