VITAMIN B12 INJECTION INFORMED CONSENT

What Are the Benefits of Vitamin B12?
• Improves energy and stamina
• Improves sleep quality and duration
• Increases metabolism
• Improves mental clarity
• Helps to balance the immune system

How Often Can I Have Vitamin B12 Injections?
• Vitamin B12 shots are the most effective when taken at regular intervals.
• We generally recommend once weekly for 4 weeks, followed by once a month.
• A regular injection schedule can be individualized.
• The cost is $20 per treatment and only takes a few minutes.

Facts about Vitamin B12
• As we age we absorb less Vitamin B12 from our daily diet.
• It is estimated 85% of us come up short of the necessary B12 from our diet.
• Absorption of B12 in food requires a substance made by our stomach called Intrinsic Factor, the production of Intrinsic Factor decreases with age. The American
College of Physicians assumes that no one has Intrinsic Factor past age 70.
• People with chronic fatigue or anemia require regular injections of vitamin B12 because the oral form is unreliable.

Side effects and warnings
• There can be some redness and/or swelling at the injection site after an injection. This redness and/or swelling should begin to go away within 48 hours.
• This redness and/or swelling may occur randomly or every time. It is generally not meaningful but can be uncomfortable.
• Vitamin B12 is generally safe for most people. Pregnant or lactating women should speak to their doctor prior to starting a B12 regime.
• Sensitivity to either Vitamin B12 and/or cobalt is a contraindication
• Clients with chronic liver and/or kidney dysfunction, Leber’s disease (hereditary eye disease) or abnormal red blood cells (megaloblastic anemia) should not take
frequent B12 injections.

By signing below, I acknowledge that I have read the foregoing informed consent and agree to the treatment with its associated risks. I hereby give consent to perform this and all subsequent B12 Injections.

Client Signature: _______________________________________Date: _________________