Phentermine

What is Phentermine?

Phentermine is a prescription medication commonly used to assist with weight loss. It is prescribed to individuals who are significantly overweight and have struggled to lose weight through diet and exercise alone. This medication works by suppressing appetite and boosting energy, helping individuals reach their weight loss goals under medical supervision.

Phentermine Benefits

Phentermine offers several key benefits for weight loss, including:

Appetite Suppression: Reduces hunger, helping you consume fewer calories.

Increased Energy: Boosts energy, encouraging more physical activity.

Faster Metabolism: May speed up metabolism, burning more calories even at rest.

Improved Focus: Helps improve concentration, keeping you motivated during your weight loss journey.

How Phentermine Works

Phentermine works by influencing chemicals in the brain that control hunger and energy levels. By reducing hunger and increasing energy, it encourages individuals to eat less and stay more active, both of which are critical factors for successful weight loss. These effects, when combined with a healthy diet and regular exercise, can help individuals lose weight effectively.

Proper Usage and Dosage of Phentermine

Phentermine should be taken exactly as prescribed by your doctor. Typically, it is taken once daily in the morning, either before or 1-2 hours after breakfast. The dosage depends on your specific needs and health conditions, as determined by your healthcare provider. Always follow your doctor’s instructions to ensure optimal results and avoid any complications.

Side Effects of Phentermine

Like all medications, Phentermine may cause side effects. Common side effects include:

Dry mouth
Difficulty sleeping
Dizziness
Headaches
Upset stomach

If you experience any of these side effects, contact your assigned doctor to discuss them. Your doctor may adjust your dosage or recommend alternative treatments if necessary.

Must complete this form before payment.

Phentermine

Consultation Or Refill?

Consultation - $149

Monthly Refill - $89

Full Name

Birth Date

Occupation

Email Address

Phone Number

Gender

Male

Female

Are you pregnant or intend to get pregnant soon?

Yes

Height

Weight

Address

Do you have allergies?

Yes

List Of Allergies

Current Medications: (Please include OTC & supplements)

Are you breastfeeding a baby?

Yes

Are you taking any other appetite suppressants?

Yes

Are you taking any medication that contains diethylpropion or ephedra?

Yes

Are you taking MAO inhibitors such as (moclobemide, phenelzine, selegiline, isocarboxazid, procarbazine, rasagiline, linezolid, and metaxalone)?

Yes

Do you have any allergy to decongestants or any appetite suppressants like diethylpropion?

Yes

Do you have a substance abuse disorder now or in the past?

Yes

Are you taking any medication that may cause dizziness, like (zolpidem, Lorazepam, antihistamine like cetirizine and Benadryl) anything with codeine or hydrocodone?

Yes

You will inform your provider if you become pregnant or plan to become pregnant.

Yes

Addiction to drugs/alcohol, heart murmur, glaucoma, chest pain, Problems with the heart, kidney problems, Thyroid problems, Depression, Thoughts of harming yourself, stroke?

Yes

You agree not to use any street drugs or other controlled substances while taking this medication.

Yes

You will be honest about all the medications you are currently taking.

Yes

You will be truthful about your full health history to your healthcare provider.

Yes

You will inform your medical provider of your complete health history.

Yes

You will inform your provider if you are hospitalized or visit the ER for any reason.

Yes

You will follow the prescribed instructions for taking this medication.

Yes

You will report any side effects immediately to your healthcare provider.

Yes

You will not share, trade, or sell your medication.

Yes

You accept responsibility for any accidental or intentional overdose and will seek medical help by calling 911 if needed.

Yes

You will ensure that the medication is stored safely out of reach of children.

Yes

You understand that stopping the medication suddenly may result in withdrawal symptoms.

Yes

By agreeing to these terms, you acknowledge that the proper use of this medication is a key part of your treatment plan.

Based on your responses, please contact Dr. James before moving forward.

Read Directions & Side Effects & Acknowledgment

Do not stop medication abruptly. Notify the Provider if you intend to stop taking medication. This medication needs to be tapered down. It may cause signs of depression and or anxiety if stopped immediately. Or feel overly tired.
Do not take this medication if you feel dizzy or drive after taking medication. Using this medication with alcohol and marijuana can cause severe dizziness. Please do not combine this medication with them.
Caffeine and excessive use of chocolate and alcohol may increase the side effects of this medication.
If you have an overdose, please call 911 or the poison control center for US residents at 1-800-222-1222. Symptoms of overdose may manifest as fast breathing, chest pain, irregular heartbeat or slow heartbeat, loss of consciousness, hallucination, and or seizure.
Do not share this medication with anyone. We must monitor your lab results regularly. Please keep all your lab appointments when necessary.
A missed dose can be taken immediately. Please only take it on time in the afternoon, and do not double up on your dose.
Medication should be stored away from moisture, light, children, and pets. It should also be disposed of properly, not down the drain.
I acknowledge that some of the side effects of taking this medication may include
Dizziness, Dry mouth, Difficulty sleeping, Irritability, Constipation, Nausea, Vomiting, Diarrhea, Elevated Blood pressure
Severe side effects that will result in stopping your medication include hallucinations, fast heartbeat, uncontrolled movements of the muscle, not being able to control your anger, severe nervousness, irregular heartbeat, or mood disorders. Severe headache, weakness, vision changes, trouble speaking, weakness, seizures, chest pain, difficulty breathing with exercise, swelling of the ankles or feet, severe itching, throat and tongue swelling, or difficulty breathing.
I acknowledge that I have not experienced any of these symptoms while taking the medication, and If I do, I will immediately stop the medication and notify the provider.

Read Directions & Side Effects & Acknowledgment

Directions and Side Effects

Do not take this medication if you feel dizzy or drive after taking medication. Using this medication with alcohol and marijuana can cause severe dizziness. Please do not combine this medication with them.

Caffeine and excessive use of chocolate and alcohol may increase the side effects of this medication.

If you have an overdose, please call 911 or the poison control center for US residents at 1-800-222-1222. Symptoms of overdose may manifest as fast breathing, chest pain, irregular heartbeat or slow heartbeat, loss of consciousness, hallucination, and or seizure.
Do not share this medication with anyone. We must monitor your lab results regularly. Please keep all your lab appointments when necessary.

A missed dose can be taken immediately. Please do not take it late in the afternoon, and do not double up on your dose.
Medication should be stored away from moisture, light, children, and pets. It should also be disposed of properly, not down the drain.

I acknowledge that some of the side effects of taking this medication may include
Dizziness, Dry mouth, Difficulty sleeping, Irritability, Constipation, Nausea, Vomiting, Diarrhea, Elevated Blood pressure
Severe side effects that will result in stopping your medication include hallucinations, fast heartbeat, uncontrolled movements of the muscle, not being able to control your anger, severe nervousness, irregular heartbeat, or mood disorders. Severe headache, weakness, vision changes, trouble speaking, weakness, seizures, chest pain, difficulty breathing with exercise, swelling of the ankles or feet, severe itching, throat and tongue swelling, or difficulty breathing.

Directions and Side Effects

Caffeine and excessive use of chocolate and alcohol may increase the side effects of this medication.

Medical Weight Loss Consent Form

I, authorize Naturopathic & Virtual eVisits LLC, or advanced practice clinician (s) and/or whoever may be designated as the medical assistant(s) to help me in my weight reduction efforts. I understand that my program may consist of a balanced deficit diet, a regular exercise program, instruction in behavioral modification techniques, and may involve the use of appetite suppressant medications. Other treatment options may include a very low-calorie diet or a protein-supplemented diet. If appetite suppressants are prescribed, they may be used for durations exceeding those recommended in the medication package insert. It has been explained to me, to my complete satisfaction, that these medications have been used safely and successfully in private medical practices as well as in academic centers for periods exceeding those recommended in the medication product literature. 
I understand that any medical treatment may involve risks and the proposed benefits. I also understand that there are certain health risks associated with remaining overweight or obese. Risks associated with remaining overweight are tendencies to have high and increasing higher blood pressure, diabetes, heart attack and heart disease, arthritis of the joints including hips, knees, feet and back, sleep apnea, and sudden death. I understand that these risks may be modest if I am not significantly overweight but will increase with additional weight gain. 
I understand that much of the program's success will depend on my efforts and that I have not been assured that it will be successful. I also understand that obesity may be a chronic, life-long condition that may require drastic changes in eating habits and permanent changes in behavior to be treated successfully. 
I understand that failing to show up for an appointment I have scheduled without calling or contacting Naturopathic & Virtual eVisits LLC ahead of time represents a disruption to the clinic's operation. Failure to show up (“No-Show”) for a pre‐appointed Follow-Up Visit or to cancel at least one full business day before a scheduled visit will result in the need to pay for the missed visit and pre-pay the next Medical Weight Loss Visit. 
I have read and fully understand this consent form and “no show” policy. I have had all of my questions answered to my complete satisfaction. I have been given all the time that I need to carefully read and understand this form.

By my initials, I acknowledge that I have had an opportunity to review Naturopathic & Virtual eVisits LLC Policy and Procedure also acknowledge that I should request a copy, a copy will be provided to me.

Communication is key in providing superior care and achieving optimal results. We will do our utmost to communicate clearly and meet your expectations. In turn you will also be expected to communicate clearly with us. Please inform us if you must miss an appointment or change the care plan in some way. In order for us to provide.

Medical Weight Loss Consent Form

Privacy and Refund Policy

OUR LEGAL RESPONSIBILITIES
We are required by law to provide you with this notice. It offers information on how we may use and disclose protected health information about you and describes your rights and our obligations regarding the use and disclosure of that information. We shall maintain the privacy of protected health information and provide you with notice of our legal duties and privacy practices with respect to your protected health information. We reserve the right to change these policies at any time. If we change our privacy policies, we will notify you. This current policy is in effect unless otherwise stated. If the policy is changed, it will apply to all your current and past health information. You may request a copy of our notice at any time. You may contact DR J IV Hydration & Wellness Clinic, LLC at 26 Academy Ave, Chester, NY 10918, or at 845-572-0889 to request a copy of this privacy policy.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The following examples describe ways we may use your protected health information for your treatment, payment, healthcare operations, etc., but please note that not every use or disclosure in a particular category will be listed.
Treatment: We may use and disclose your protected health information to provide you with treatment. This includes disclosing your protected health information to other medical providers, trainees, therapists, medical staff, and office staff involved in your healthcare. For example, your medical provider might need to consult another provider to coordinate your care. Also, the office staff may need to use and disclose your protected health information to individuals outside of our office, such as a pharmacy when a prescription is called in.
Payment: Your protected health information may also be used to obtain payment from an insurance company or another third party. This may include providing an insurance company with your protected health information for pre-authorization of a medication we prescribed.
Healthcare Operations: We may use or disclose your protected health information to operate this medical practice. These activities include training students, reviewing cases with employees, using your information to improve the quality of care, and contacting you by telephone, email, or text to remind you of your appointments. If we need to share your protected health information with third-party "business associates," such as a billing service, we will have a written contract in place to protect the privacy of your protected health information.
Marketing: We may also use and disclose your protected health information for marketing activities. For example, we might send you a thank you card in the mail with a coupon for specialized services or products. We may also send you information about products or services that might interest you. You can contact us at any point to stop receiving this information.
We will not use or disclose your protected health information for any purpose other than those identified in this policy without your written authorization. You may provide us with written authorization to use or disclose your protected health information to anyone. You can revoke this authorization at any time, but it will not affect the protected health information that was shared while the authorization was in effect.
Appointment Reminders: We may contact you to remind you of appointments for your initial visit, follow-up visit, or lab work via text, phone, or email.
Others Involved in Your Healthcare: We may disclose protected health information about you to family members or friends if we obtain your verbal agreement to do so, or if we give you an opportunity to object to such a disclosure and you do not raise an objection. For example, we may assume that if your spouse or friend is present during your evaluation, we can disclose protected health information to this person. If you are unable to agree or object to such a disclosure, we may disclose the necessary information based on our professional judgment if there is an urgent or emergent need.
Research: We will not use or disclose your health information for research purposes unless you give us authorization to do so.
Organ Donation: If you are an organ donor, we may release protected health information to organizations that handle organ procurement or organ, eye, or tissue transplantation if it is necessary to facilitate the process.
Public Health Risks: We may disclose your protected health information if necessary to prevent or control disease, report adverse events from medications or products, or prevent injury, disability, or death. This information may be disclosed to healthcare systems, government agencies, or public health authorities. We may also have to disclose your protected health information to the Food and Drug Administration to report adverse events, defects, problems, or enable recalls if required by FDA regulation.
Health Oversight Activities: We may disclose protected health information to health oversight agencies for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for state and federal agencies to monitor healthcare systems and compliance with civil law.
Required by Law: We will disclose protected health information about you when required by federal, state, and/or local law.
Workers’ Compensation: We may disclose your protected health information to workers’ compensation or similar programs.
Lawsuits: We may disclose your protected health information in response to a court action, administrative action, or subpoena.
Law Enforcement: We may release protected health information to a law enforcement official in response to a court order, subpoena, warrant, or subject to all applicable legal requirements.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
Access to Medical Records: You have the right to access and receive copies of your protected health information used to make decisions about your care. You must submit a written request to obtain your protected health information. We reserve the right to charge a fee for the time it takes to obtain and copy the protected health information.
Amendment: If you believe the protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You will need to submit a written request explaining why you believe the information should be amended. We may deny your request if you did not provide a written request or a reason for the amendment. If we deny your request, we will provide a written explanation. We may also deny your request if we believe the protected health information is accurate and complete.
Accounting of Disclosures: You have the right to receive a list of instances where we disclosed your personal health information unless the disclosure was for treatment, payment, healthcare operations, or was pursuant to a valid authorization. You must submit a written request to obtain this "accounting of disclosures." After your request is approved, we will provide the dates of the disclosure, the name of the individual or entity we disclosed the information to, a description of the information that was disclosed, and the reason for the disclosure. This information may cover up to five years prior to the date of the request. We reserve the right to charge a reasonable fee for this process.
Restriction Requests: You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment, or healthcare operations. We will accommodate your request unless the disclosure is required by law. You must submit this request in writing.
Confidential Communication: You have the right to request that we communicate with you about healthcare matters in a certain way or at a certain location. We must accommodate your request if it is reasonable and allows us to continue billing and collecting payments.
Paper Copy of This Notice: You may request a hard copy of this privacy policy, even if you reviewed and signed it electronically. To obtain a copy, contact the individual at the end of this policy.
Complaints: If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.

Privacy and Refund Policy

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I agree with the directions, indemnification clause and privacy policy.

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Phentermine

What is Phentermine?

Phentermine Benefits

How Phentermine Works

Proper Usage and Dosage of Phentermine

Side Effects of Phentermine

Must complete this form before payment.

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