Weight Loss Program

Semaglutide

Semaglutide, often known under the brand name Ozempic, is a glucagon-like peptide-1 (GLP-1) receptor agonist. It is mainly used to improve blood sugar control in adults with type 2 diabetes. More recently, it has been approved for chronic weight management in adults.

Semaglutide works by mimicking the function of a natural hormone in your body called GLP-1. It helps to regulate your appetite, reducing feelings of hunger and helping you eat less. Additionally, it promotes insulin production and reduces the amount of glucose produced and released by your liver.

Vitamin B12

Vitamin B12 is a nutrient that aids in the proper functioning and health of nerve tissue, brain function, and red blood cell production. It is essential for a healthy metabolism. B12 injections are often used to treat deficiencies, but they're also popular in weight loss regimens because they can boost energy and metabolism, helping to increase activity levels and burn more calories.

The Semaglutide/B12 injection is usually administered once weekly. You should follow your healthcare provider's specific instructions for the dosage and frequency of injections. The medication is typically injected under the skin (subcutaneously) in the stomach, thigh, or upper arm.

Make sure to rotate the injection site each time to reduce the risk of developing skin reactions. Never inject into a vein or muscle.

Like all medications, the Semaglutide/B12 injection can have side effects. Common ones include:

Nausea

Vomiting

Diarrhea

Abdominal pain

Decreased appetite

These side effects are often temporary and may lessen as your body adjusts to the medication. However, if they persist or worsen, you should contact your healthcare provider.

Inform your healthcare provider if you have a history of thyroid cancer or a type of thyroid disease called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Before starting semaglutide/B12 injections, inform your healthcare provider about any allergies or medical conditions you may have, especially if you have a history of pancreatitis, kidney disease, or liver disease.

Furthermore, while B12 is generally safe, in very high doses, it might interact with certain medications. Let your healthcare provider know about all medications and supplements you're currently taking.

Lastly, semaglutide may affect your blood sugar levels, so be sure to monitor your blood sugar as directed and share the results with your doctor.

Step 1:

Call or text our Royal Oak or Port Huron location to schedule a virtual consultation with our doctor for our pre-treatment screening. During the virtual consultation the doctor will ask you a variety of questions to verify you are a good candidate to receive treatment. Criteria for treatments start with a BMI greater than 25. You should avoid this treatment if you have a history of medullary thyroid cancer, history of gallbladder disease, history of pancreatitis, and/or a history of MEN2.

Step 2:

Once the doctor approves you to receive treatment, you will be able to book an in-person appointment with one of our nurses. The day after your appointment with the doctor, one of our CC Client Coordinators with call you to schedule this appointment. During your first appointment with the nurse, you will be measured and weighed, go over any remaining questions/concerns you may have, receive your first injection, and also receive instructions on how to perform the injections at home. At the end of the appointment, you will receive your first month’s supply of medication to take home, and pre book for your next month’s appointment.

$350/month

$300/month for CC Members

The purpose of this consent form is to provide written information regarding the risks, benefits and alternatives of treatment with semaglutide and Vitamin B12. This material serves as a supplement to the discussion you have with your Crawford Cosmetics provider. It’s important that you fully understand this material, so please read this information thoroughly. If you have any questions regarding the medications and process, ask your Crawford Cosmetics provider prior to signing this consent form.

TREATMENT GOALS AND DESCRIPTION OF PROCEDURE Semaglutide with Vitamin B12 is an injectable compounded medicine used for adults with obesity or overweight (excess weight) to help them lose weight and keep the weight off. The compound formulation is a combination of Semaglutide and Vitamin B12 which are targeted to treat excess weight and alleviate potential side effects from the Semaglutide such as nausea. Given the original trials and studies did not contain Semaglutide and Vitamin B12, outcomes and side effects may differ. Semaglutide should be used with a reduced-calorie meal plan and increased physical activity. The procedure involves a weekly subcutaneous injection and a monthly physical exam. This procedure may be considered medically unnecessary. It may or may not mitigate, alleviate, or cure the condition for which it has been prescribed. This therapy has been recommended to you in the belief that it is of potential benefit in these circumstances and its use will probably improve the condition for which you are under treatment and your overall health.

TREATMENT RESULTS Most patients are pleased with the results of Semaglutide and Vitamin B12. However, there is no guarantee that you will be completely satisfied. Since every human being is unique, we cannot guarantee any specific result from Semaglutide and Vitamin B12 treatment. Treatment will be discontinued after 12 weeks if you have not lost at least 5% of your initial body weight. In trials of Semaglutide at 2.4mg dosing (such as STEP 1 trial) the average weight loss 14.9% compared with 2.4% without Semaglutide. 86.4% of people lost at least 5% of their body weight. Like with many other forms of weight loss medications as well as gastric bypass, weight loss tends to plateau or level off after approximately 68 weeks for Semaglutide. After discontinuation of Semaglutide, weight gain can occur especially if a healthy lifestyle and diet are not maintained. Given the original trials and studies did not contain compounded Semaglutide and Vitamin B12, outcomes and side effects may differ.

AFTERCARE INSTRUCTIONS Following your procedure, we’ll provide you with verbal and/or written aftercare instructions. If at any time you suspect you’re having an unexpected side effect, adverse reaction or complication, contact us immediately, and obtain help in an appropriate medical setting (i.e. Crawford Cosmetics, your primary care provider, specialist, urgent care, or acute care facility). I will adhere to the aftercare instructions supplied to me during my visit.

POTENTIAL RISKS AND COMPLICATIONS Before undergoing this program, understanding the risks is essential. The following risks may occur, but there may be unforeseen risks and risks that are not included on this list. Some of these risks, if they occur, may necessitate hospitalization, and/or extended outpatient therapy. I understand that there are certain inherent and potential risks and side effects with any medication, and in this specific instance such risks include but are not limited to: altered sense of taste, dry mouth, insomnia, asthenia; burping; constipation; diarrhea; dizziness; dry mouth; gallbladder disorders; gastrointestinal discomfort; gastrointestinal disorders; insomnia; nausea; vomiting, hypoglycemia, dyspepsia, gastritis, gastro-esophageal reflux disease, flatulence, eructation, upper abdomen pain, abdomen distension, cholelithiasis, injection site reactions, fatigue, increased lipase and increased amylase. Uncommon side effects are pancreatitis, tachycardia, hives, anaphylaxis, kidney injury, allergic reaction. Semaglutide may cause thyroid C-cell tumors in rats and mice. It is unknown whether Semaglutide causes thyroid C-cell tumors, including medullary thyroid carcinoma (cancer, MTC), in humans, as the human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined. Patients should be aware of symptoms of thyroid tumors (such as a mass in the neck, difficulty swallowing, difficulty breathing or shortness of breath, persistent hoarseness) and report symptoms to their provider. If more significant side effects or symptoms occur, you may be referred to your primary care doctor or emergency room for further workup if deemed necessary by your provider.

PREGNANCY AND CONTRAINDICATED CONDITIONS I am not aware that I am pregnant. I am not trying to get pregnant. I am not lactating (nursing). I do not have any major illnesses which would prohibit me from receiving Semaglutide and Vitamin B12. I do not have severe renal disease, severe liver disease, family history of medullary thyroid cancer (MTC), Hypersensitivity to Semaglutide, concurrent treatment with any other products for weight management, weight problems related to endocrinological or eating disorders, concurrent insulin or sulfonylurea that was not disclosed to provider, congestive heart failure, history of pancreatitis, gallbladder disease not disclosed to provider, inflammatory bowel disease, diabetic gastroparesis, or a personal or family history of MEN 2 (Multiple Endocrine Neoplasia syndrome).

ALTERNATIVE THERAPY I understand that this is an elective program with a goal of weight loss. Other available therapies might include a balanced calorie counting program, exchange eating program, gastric bypass, or various other diets.

PAYMENT I understand that this program is not covered by insurance, and payment is my responsibility and is expected at the time of treatment.

RIGHT TO DISCONTINUE TREATMENT I understand that I have the right to discontinue the program and medications at any time.

RELEASE OF LIABILITY I hereby indemnify Crawford Cosmetics, PLLC from any liability relating to the Semaglutide program and administration of Semaglutide and Vitamin B12 that I have volunteered for. I understand that any treatment performed is between me and the doctor/healthcare provider who is treating me and I will direct all post-treatment questions or concerns to the treating clinician. Furthermore, I hereby indemnify the facility where this treatment is being performed from any liability relating to the procedures that I have volunteered for.

CONSENT TO TREATMENT I hereby voluntarily consent to treatment with Semaglutide and Vitamin B12 for weight loss as performed by my Crawford Cosmetics provider. I have read the above and understand it. I state that I read and write in English. I am not under the influence of drugs or alcohol. The treatment has been fully explained to me and my questions have been answered satisfactorily. I accept the risks and complications of this elective program and I understand that no guarantees are implied as to the outcome of the program. Please note this consent is valid for all future Semaglutide and Vitamin B12 administrations I choose to receive from Crawford Cosmetics.

Our goal is to provide quality aesthetic treatments to all our clients in a timely manner. No-shows, late arrivals, and cancellations inconvenience not only our providers, but our other clients as well. Please be aware of our policy regarding missed appointments. Your appointments and well-being are very important to us. We understand that sometimes unexpected issues arise.

Appointment Cancellation

Our policy enforces a late cancellation fee for cancellations made with less than a 72-hour notice. It is important to understand that you will forfeit your deposit for any appointment cancelled inside the 72-hour cancellation window. If you no call/no show, in addition to forfeiting your deposit, you will be charged a fee of $100. We take No call/No shows very seriously. We make all efforts to avoid these fees for you by sending multiple texts and email reminders that allow ample time to cancel or reschedule your appt with us.

When you book your appointment, you are holding a space on our calendar that is no longer available to our other clients. To hold this appointment, we require a credit card on file, and partially refundable $75 deposit for appointments under 30 mins ($67.50 will be refunded), and $200 partially refundable deposit for appointments over 30 mins ($180 will be refunded). Shorter appointments with our estheticians require a smaller deposit and are partially refundable. Other appointment deposits many vary. The deposit will be applied toward the cost of your treatment and is partially refundable if you do not receive treatment at the time of your appointment. In order to be respectful of your fellow clients, please notify your Crawford Cosmetics provider as soon as you know you will not be able to make your appointment.

Please note, if you are more then 10 minutes late for your scheduled appointment, your appointment will be automatically cancelled, you will lose your deposit, and will be charged the additional no show fee of $100.

If cancellation is necessary, we require that you call, text, or cancel online at least 72 hours in advance. Appointments are in high demand, and your advanced notice will allow another client access to that appointment time. As we are closed over the weekend, if you have a Monday appointment, we require that you cancel the Wednesday before by 5pm. If you have a Tuesday appointment, we require that you cancel the Thursday before by 5pm at the latest. Appointments are in high demand, and your advanced notice will allow another client access to that appointment time.

How to Cancel Your Appointment

If you need to cancel your appointment and are enrolled in text message reminders, you can reply "no" to the reminder text that you will receive 4 days prior to the appointment. Other options are: cancel online, call or text the scheduling line, Port Huron (248) 285-9876 or Royal Oak (248) 221-1895, during regular business hours, or text your Crawford Cosmetics provider. If necessary, please leave a detailed voicemail message and we will return your call as soon as possible. Please note, if you cancel your appointment through our automatic text message reminder or online, you must reach out to us for the refund, as is not returned automatically and remains on file unless a refund is requested.

Late Cancellations vs. No-Shows

A cancellation is considered late when the appointment is cancelled with less than 72 hours' notice. A no-show is when a client misses an appointment without cancelling.

It is important to understand that you will forfeit your deposit for any appointment cancelled inside the 72hour cancellation window. If you no call/no show, in addition to forfeiting your deposit, you will be charged a fee of $100. These fees will automatically be applied to the credit card on file. If the credit card is rejected, any fee that is owed must be paid in full prior to booking any future appointments.

I confirm that I have read, understand and agree to the above policy.