Rules For Use Of Anti-Obesity Control Medications
NOTE: SIGNING THIS FORM DOES NOT GUARANTEE THAT YOUR PROVIDER(S) ATBWMedMD WILL FIND YOU TO BE AN APPROPRIATE CANDIDATE FOR ANTI-OBESITYMEDICATIONS, BUT ONLY THAT YOU HAVE READ, UNDERSTOOD, AND AGREE TO THETERMS OF MEDICATION USAGE SHOULD YOU AND DR. O. AKINRULI DECIDE UPONTHEIR USAGE NOW OR IN THE FUTURE.
I agree that it is my responsibility to inform my physician(s) at BWMedMD and any otherproviders from whom I receive treatment of all medications prescribed to me. I understand that the use of anti-obesity medications is contraindicated with certain medical histories,allergies, or other medication use.
I agree that I will be completely honest in disclosing this information and will notify myphysician(s) at BWMedMD of any changes to my medical history or medication usage. I understand that failure to do so can be dangerous to my health.
I agree to take the medication only as prescribed and directed by Dr. Omowunmi Akinruli. I understand that taking medications in any way other than as directed and prescribed could affect my health and be dangerous. I also understand that medications are typically considered after a trial of failed weight loss with only nutritional/behavior modifications. If I am deemed a candidate for the medication program at BWMedMD, I am aware that the lowest effective dosage will be tried prior to increasing dosages.
I understand that medication prescriptions can be filled at a pharmacy of my choice. I agree to use only one pharmacy at a time to fill any scheduled anti-obesity prescriptions, and I give my permission for BWMedMD to notify area pharmacies of the terms of this agreement.
I will not share, sell, or trade my medication with anyone. I understand that doing so is illegal and will result in my discharge from the care of BWMedMD.
I understand that the use of some of the anti-obesity medications beyond 12 weeks is considered “off label” or not initially approved by the U.S. Food and Drug Administration (FDA). I understand that my physician(s) at BWMedMD is experienced in the area of obesity medicine and will, at times, elect/choose to use the anti-obesity medication(s) for longer periods of time as deemed appropriate for my individual treatment.
I understand that I am to report any side effects or adverse reactions of my medications to the physician(s) at BWMedMD.
I agree that my physician(s) at BWMedMD may sometimes taper and/or stop my medication to evaluate its effect on my weight loss and/or hunger and health.
I understand that much of the success of the program will depend on my efforts and that there are NO GUARANTEES in medical treatment in the disease of obesity. I also understand that I will have to continue monitoring my weight after active weight loss.