Peptide Therapy Informed Consent

Section 1 — Nature of This Consultation

I understand that this consultation with Dr. Edward Rubin is provided for educational purposes only. Dr. Rubin is acting in an advisory and informational capacity regarding peptide therapy options. He is not prescribing peptides and does not have a prescribing relationship with me in connection with this consultation.

The information provided is intended to help me understand the current landscape of peptide therapies, their reported uses, and relevant considerations for my own health decisions. Nothing discussed constitutes a formal diagnosis or a physician-patient treatment relationship with respect to peptide therapy.

Section 2 — Experimental Status & Known Risks

I understand and acknowledge all of the following:

• •Peptide therapies are not FDA approved for most uses discussed in this consultation. They are considered experimental or investigational.
• •The long-term effects of most peptides are not fully known. There are significant gaps in the scientific literature regarding safety, dosing, and efficacy.
• •The regulatory status of peptides may change, which could affect their availability.
• •Results are variable and not guaranteed. Individual responses may differ significantly.
• •These therapies are not covered by health insurance, and I am solely responsible for any costs incurred.

Section 3 — Patient Autonomy & Direct Pharmacy Relationship

I understand that any decision to obtain or use peptide therapies is entirely my own. If I choose to pursue peptide therapy based on information provided in this consultation, I will do so through a direct relationship with a compounding pharmacy of my choosing.

Dr. Rubin may make recommendations regarding compounding pharmacies he has experience with. This consent acknowledges that Dr. Rubin has a financial relationship with certain compounding pharmacies; this disclosure is provided to ensure full transparency.

I accept full personal responsibility for any peptides I obtain and use, understanding that Dr. Rubin bears no liability for adverse outcomes arising from my independent decision to pursue this treatment.

Section 4 — Acknowledgment & Release

By signing below, I confirm that I have read and understand the information provided in this consent form. I have had the opportunity to ask questions and have received answers to my satisfaction. I voluntarily choose to proceed with this educational consultation with Dr. Rubin, acknowledging its advisory nature and the experimental status of the therapies discussed.

I release Dr. Edward S. Rubin, M.D. P.C. and associated staff from any liability arising from my independent decisions regarding peptide therapy made following this consultation.