Consent for Tele-Metabolic Care & GLP-1 Therapy

1. Introduction and Purpose

I, the undersigned, voluntarily agree to participate in the InGoodHands Metabolic Care Program. I understand that this program involves a medically supervised weight-loss strategy utilizing Glucagon-Like Peptide-1 (GLP-1) or Gastric Inhibitory Polypeptide (GIP) receptor agonists, integrated with nutritional counseling and lifestyle modifications.

2. Nature of Telemedicine Services

I understand that "Telemedicine" involves the use of electronic communications to enable healthcare providers at different locations to share individual patient medical data for the purpose of improving patient care.

• Integrated Metabolic Care: I understand that InGoodHands is a comprehensive medical program. Along with obesity management, I will receive clinical treatment and guidance for associated metabolic disorders or comorbidities (such as Type 2 Diabetes, PCOS, Hypertension, or Dyslipidemia) as deemed necessary by the Physician.
• Limitations: I acknowledge that a tele-consultation is not the same as an in-person visit. The physician cannot perform a physical examination (such as palpation of the thyroid or abdomen).
• Technical Risks: I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties.
• Alternative: I am aware that I have the option to seek in-person medical care at any time.

3. Medical Risks and Side Effects of Therapy

I have been informed of the potential side effects associated with GLP-1/GIP medications, which include but are not limited to:

• Gastrointestinal Issues: Nausea, vomiting, diarrhea, constipation, and abdominal pain.
• Serious Risks: Although rare, there is a risk of acute pancreatitis, gallbladder disease, and kidney impairment.
• Muscle Loss (Sarcopenia): I understand that rapid weight loss can lead to the loss of lean muscle mass unless I strictly follow the protein intake and resistance training protocols provided.
• Thyroid Risk: I confirm I have no personal or family history of Medullary Thyroid Carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

3.1 Disclosure of Medication Profile (Generics)

• Non-Innovator Status: I acknowledge that the medication being prescribed is a generic formulation and not the innovator brand (e.g., Ozempic® or Wegovy®).
• Recent Market Entry: I am aware that these generic versions have been recently launched in India. Consequently, while they meet current regulatory standards, they lack the extensive long-term safety and efficacy data (spanning many years) that is available for the innovator products.
• Acceptance of Risk: I understand that the long-term profile of this specific generic formulation is still being established through ongoing real-world use, and I voluntarily accept the risks associated with using a recently launched therapeutic.

4. Risk of Weight Regain after Discontinuation

I have been clearly informed that:

• Chronic Management: Obesity is a chronic biological condition. GLP-1/GIP medications work by regulating appetite and metabolic signals while they are being administered.
• Regain Risk: Clinical data indicates a significant risk of weight regain if the medication is discontinued without a robust foundation of lifestyle changes and a supervised "Biological Stabilization" or tapering phase.
• Tapering Importance: Discontinuing the medication abruptly against medical advice increases the likelihood of a "metabolic rebound," where hunger levels and weight may return to baseline.

5. Patient Responsibilities and Accuracy of Information

I agree that:

• True Disclosure: All information provided by me—including medical history, weight, age, Aadhaar details, and current medications—is true and accurate.
• Lab Compliance: I will complete all mandatory baseline and follow-up blood investigations as prescribed.
• Dosage Adherence: I will not alter my medication dose without explicit written approval from the clinical team.
• Lifestyle Commitment: I understand that medication is a "biological tool" and that long-term success requires my adherence to the prescribed diet and exercise plan.
• Ad-hoc & Repeat Investigations: I acknowledge that the initial program package includes a specific set of baseline laboratory investigations. However, the Physician reserves the right to order repeat or additional tests at any point during the program (e.g., for titration of diabetes medication, monitoring of organ function, or safety surveillance). The costs for such supplemental or repeat investigations shall be borne separately by me and are not included in the standard program fee.

6. Emergency Protocol and Safety

• In-Person Requirement: I understand that InGoodHands is not an emergency service.
• Severe Symptoms: If I experience severe abdominal pain, persistent vomiting, signs of an allergic reaction (swelling, difficulty breathing), or any other medical emergency, I will immediately stop the medication and seek care at the nearest physical Emergency Room (ER) or hospital.
• Reporting: I will notify the InGoodHands clinical team of any ER visits or hospitalizations within 24 hours.

7. Privacy, Data Security, and Confidentiality

• I consent to the digital storage of my medical records, video consultations, and lab results.
• InGoodHands adheres to data privacy standards; however, I understand that no digital platform is 100% secure.
• My data may be used in an anonymized, de-identified format for clinical audits or research to improve the program.

8. Voluntary Participation and Withdrawal

I understand that my participation is voluntary. I may withdraw from the program at any time; however, I am aware that stopping metabolic medication abruptly should be done under medical guidance to manage potential rebound effects.

9. Acknowledgment and Consent

By signing this form (or checking the "I Accept" box on the digital platform), I confirm that:

• I have read and understood the information provided above.
• I have had the opportunity to ask questions during my initial consultation.
• I voluntarily choose to proceed with the InGoodHands Metabolic Care Program.

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