Terms and Conditions

Terms and Conditions. Consent for treatment.

Patient General Consent for Treatment with Leonel Cordova, M.D. / DrVitaminIV

This consent form is to confirm your agreement to receive treatment and care from Leonel Cordova, M.D. / DrVitaminIV. By signing this document, you acknowledge and consent to the following terms regarding your treatment:

Scope of Care:

You understand that the care provided by Leonel Cordova, M.D. / DrVitaminIV includes treatment for minor medical conditions and is not intended to substitute for your Primary Care Physician or higher levels of medical care. The services offered are designed to address non-emergency, non-life-threatening conditions, and are aimed at enhancing your overall well-being through IV therapy and other wellness treatments.

Exclusion of Chronic and Emergency Conditions:

You acknowledge that Leonel Cordova, M.D. / DrVitaminIV does not treat chronic conditions or conditions requiring emergency medical attention or life-threatening situations. You are advised to seek immediate care from a hospital or an emergency medical facility for such conditions.

You agree to maintain a relationship with your Primary Care Physician and other medical specialists as required, for the ongoing management of any chronic or serious health conditions.

Consent to Treatment:

You voluntarily consent to receive treatment from Leonel Cordova, M.D. / DrVitaminIV, understanding the scope and limitations of the care provided.

You confirm that you have discussed any potential risks and benefits associated with the proposed treatments and that any questions or concerns have been adequately addressed.

Personal Health Information:

You consent to the sharing of your personal health information as necessary for treatment, payment, and healthcare operations, in compliance with federal and state laws protecting the privacy and security of your medical information.

Financial Responsibility:

You agree to be financially responsible for the services received, understanding that certain treatments may not be covered by insurance. You commit to settling any payments due for services rendered as per the agreed terms.

Right to Refuse or Discontinue Treatment:

You understand that you have the right to refuse or discontinue treatment at any time and that this decision will be respected by Leonel Cordova, M.D. / DrVitaminIV.

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Informed Consent for Medically Managed Weight Loss Therapy (When Applicable).

I acknowledge that I am voluntarily entering into a medically managed weight loss program with Leonel Cordova, MD/ DrVitaminIV, LLC. I fully realize that entering any program involving weight reduction, which includes moderate calorie restriction, exercise, and medications, involves potential risks and side effects. The risks include, but may not be limited to the following:

· Cardiovascular (heart or blood pressure): These problems may include heart palpitations, irregular beats, or rapid heartbeat. These effects are usually mild but can result in serious problems including heart attack or stroke. Also, these medications may increase blood pressure, which if left untreated can lead to heart attack or stroke. If you discontinue the weight loss medication, the elevated blood pressure usually resolves. For this reason, if you are on blood pressure medications you are required to monitor your blood pressure daily and discontinue medications if your blood pressure rises, your heart rate increases, or you feel palpitations.

· Sudden Death: Patients with morbid obesity, particularly those with hypertension, heart disease, or diabetes, have a statistically higher chance of suffering sudden death when compared to normal-weight people without such medical problems. Rare instances of sudden death have occurred while obese patients were undergoing medically supervised weight reduction, though no cause-and-effect relationship with the diet has been established. The possibility cannot be excluded that some undefined or unknown factor in the treatment program could increase this risk in an already medically vulnerable patient.

· Reduced Potassium Levels: The calorie level you will be consuming is 800 or more calories per day and it is important that you consume the calories that have been prescribed in your diet to minimize side effects. Failure to consume all of the food and fluids, nutritional supplements, or taking a diuretic medication (water pill) may cause low blood potassium levels or deficiencies in other nutrients. Low potassium levels can cause serious heart irregularities. When someone has been on a reduced-calorie diet, a rapid increase in calorie intake, especially overeating or binge eating, can be associated with bloating, fluid retention, disturbances in electrolytes, gallbladder attacks, and abdominal pain. For these reasons, following the diet carefully and following the gradual increase in calories after weight loss is essential.

· Gall Bladder Disease: Any program resulting in rapid weight loss may precipitate the formation of gallstones, which could lead to cholecystitis (inflammation of your gallbladder), which is a medical urgency or emergency and could require surgery. This is typically because of the rapid weight loss, not the medications you are taking. Symptoms include right upper abdominal pain, abdominal just below your ribs, nausea, and vomiting.

· Pancreatitis: Pancreatitis, or an infection in the bile ducts, may be caused by gallstones or the development of sludge or obstruction in the bile ducts. The symptoms of pancreatitis include pain in the left upper abdominal area, nausea, and fever. Pancreatitis may be precipitated by binge eating or consuming a large meal after a period of dieting. Also associated with pancreatitis is long-term abuse of alcohol and the use of certain medications and increased age. Pancreatitis may require surgery and may be associated with more serious complications and death.

· Psychiatric: There are reported cases of “hysterical or psychotic reactions” associated with the use or discontinuation of some of the drugs utilized for weight loss purposes. These reactions are extremely rare.

· Men over 40 and post-menopausal women in general, and patients with risk factors for cardiovascular disease should have a cardiovascular evaluation before entering a medically managed weight loss program. This may include an ECG, a stress test, or other testing procedures, as per the discretion of a cardiologist. If you are over the age of 40, post-menopausal (female), smoke, have a history of high blood pressure, or high cholesterol, or are diabetic, you acknowledge that you have had a cardiac evaluation and that you have been cleared medically prior to starting this weight loss program.

· Common, but troublesome side effects may include but not be limited to dry mouth, palpitations, “speedy” feeling, headaches, sleeplessness., Rash, fever, nausea, vomiting, allergic reactions, decreased insulin sensitivity, flushing, headache, fatigue, lightheadedness, abdominal cramping, joint pain, fluid retention, and additional side effects not listed that will be discussed during your evaluation with Leonel Cordova, MD. These side effects are generally rare, and most patients tolerate treatment without an issue.

· Drug interactions may occur if other medications are taken. Therefore, I will check with my prescribing medical provider before starting the program if I am taking other medications.

· Certain medical conditions may be worsened if on this program, including glaucoma, hypertension, and heart disease.

· Pregnancy (Females Only). If you become pregnant, inform your physician immediately. Your diet must be changed promptly to avoid further weight loss because a restricted diet could be damaging to a developing fetus. You must take precautions to avoid becoming pregnant during the course of weight loss.

· The use of medications for weight management is indicated for those patients who have a BMI of 30 or higher or a BMI of 27 or higher with other medical conditions such as high blood pressure, diabetes, or high cholesterol. Prescribing medications for patients not fitting these criteria is considered “off-label” and not “FDA approved.” Therefore, the potential risks vs. benefits may be great. For patients not fitting the BMI criteria for the use of appetite suppression medication, you are acknowledging that:

a. You have put forth a true effort to lose weight through diet and exercise over the past 6 months and have still not achieved your weight loss goals.

b. That your inability to lose weight is causing significant emotional distress.

c. You are choosing to enter this medically managed weight loss program voluntarily and hold harmless Leonel Cordova, MD/ DrVitaminIV, LLC. for the use of such medications.

You acknowledge that alcohol and illicit drug use is prohibited in the program. Drugs like cocaine and amphetamines when used in conjunction with appetite suppressants and other medications prescribed could cause serious injury or death. The use of alcohol will also affect your results.

· I understand that the physician and I will determine what my daily caloric intake will be at my initial visit.

· I acknowledge that I understand that the amount of weight loss varies from patient to patient and is largely dependent on each patient’s personal motivation and commitment to their diet and exercise plan. No claims as to efficacy or a specific amount of weight loss are either expressed or implied. I understand the importance of routinely following up with Leonel Cordova, MD to monitor my progress during treatment. I understand this is vital to the safety of the treatment program and certify that I will be returning monthly as prescribed.

· I hereby authorize Leonel Cordova, MD, and additional staff to evaluate me for admission into the DrVitaminIV, LLC. weight management program and treat me accordingly. I consent to obtain blood work before treatment if deemed necessary. I certify that I am signing this under my free will and am competent to make my own medical decisions.

· I have reviewed the mentioned risks and have determined the benefits outweigh the possible risks associated with medically managed weight loss therapy with Leonel Cordova, MD/ DrVitaminIV, LLC., I release any claim in court or any type of complaint that could result from treatment with Leonel Cordova, MD/ DrVitaminIV, LLC. and any other staff associated with and will not hold liable any provider or staff of Leonel Cordova, MD/ DrVitaminIV, LLC.

· I understand the treatment modalities utilized by Leonel Cordova, MD/ DrVitaminIV, LLC. might not be supported by scientific/medical literature and could be seen as experimental or based on anecdotal claims. Many medical providers, including endocrinologists, surgeons, family practice doctors, etc., might see these types of treatments as not medically necessary. I also understand that many of the medications are being utilized within Leonel Cordova, MD/ DrVitaminIV, LLC. medically managed weight loss programs are used “off-label” and might not be FDA-approved for weight loss purposes.

· I acknowledge that I have had the opportunity to discuss any concerns and to fully understand in detail the above information, with Leonel Cordova, MD/ DrVitaminIV, LLC., either in person or by telephone/videoconference/or other HIPAA-compliant means of communication. I consent to the treatment being offered to me by Leonel Cordova, MD/ DrVitaminIV, LLC. and I am satisfied with the explanation. I acknowledge that I have read or have read to me the above and understand the information presented.

· I agree to use electronic records and signatures and I acknowledge that I have read the related consumer disclosure.

2- Risks and Benefits Acknowledgement

I recognize the potential risks of this treatment program, and I also understand the potential benefits of weight loss, which may include:

1. Decreased risk of a heart attack.

2. Decreased risk of adult-onset diabetes mellitus.

3. Decrease the risk of developing arthritis or developing musculoskeletal conditions that are caused by excessive weight.

4. Increased emotional and psychological well-being.

5. Decreased risk of developing certain types of cancer.

I acknowledge that the medically managed weight loss program recommended to me by Leonel Cordova, MD/DrVitaminIV, LLC. is just one of multiple strategies to reduce weight. Alternative treatment options include:

1. Diet and exercise alone without medications.

2. The use of other kinds of medications to achieve appetite suppression.

3. Non-medical weight loss programs like Weight Watchers.

4. Bariatric Surgery.

I acknowledge that I have had the opportunity to discuss any concerns and to fully understand in detail the above information with Leonel Cordova, MD/ DrVitaminIV, LLC., either in person or by telephone/videoconference/or other HIPAA-compliant means of communication. I consent to the treatment being offered to me by Leonel Cordova, MD/ DrVitaminIV, LLC. and I am satisfied with the explanation. I acknowledge that I have read or have read to me the above and understand the information presented.

Informed Consent for administration of Vitamins, Nutrients and other Products (When Applicable).

I will be receiving injectable vitamins and nutrients, and other products, as a medical procedure. This treatment is being administered to improve overall health and well-being, and not as a medical necessity.

Injection Procedure Description: The auto-injection procedure involves administering vitamins and nutrients and other products directly into the bloodstream. The injection will be done using a sterilized needle, inserted at an appropriate site, usually in the arm, lateral thighs, or buttocks, and will be done with the dose and frequency prescribed as per the physician's instructions.

Benefits:

1. Immediate Absorption: Auto-injections allow for the direct delivery of vitamins and nutrients and other products into the bloodstream, bypassing the digestive system. This ensures nearly 100% bioavailability, which means that the body receives more of the beneficial substances compared to oral consumption.

2. Consistency: With auto-injections, the exact amount of the nutrient or vitamin is administered, ensuring consistent dosing. This is particularly beneficial for patients who might have gastrointestinal issues that prevent proper absorption of vitamins from food or oral supplements.

3. Rapid Onset of Effects: Due to the direct introduction into the bloodstream, many patients report feeling the beneficial effects more rapidly compared to other administration methods.

4. Enhanced Energy Levels: Many individuals experience an increase in energy levels, which can lead to improved mood, better overall physical stamina, and enhanced cognitive functions.

5. Strengthened Immune System: The direct delivery of vital nutrients can bolster the immune system, making the body more resilient to infections and illnesses.

6. Reduction in Deficiency Symptoms: For patients with diagnosed deficiencies in certain vitamins or nutrients, auto-injections can rapidly alleviate symptoms related to those deficiencies, such as fatigue, dizziness, or weakened immunity.

7. Convenience: Especially for those who find it challenging to consume large pills or keep up with a regimen of multiple supplements daily, auto-injections offer a convenient alternative.

8. Customizable Treatment: Depending on the patient's specific needs, the composition of the auto-injection can be tailored, allowing for a more personalized approach to treatment.

9. Supports Overall Well-being: Beyond targeting specific deficiencies, auto-injections of vitamins and nutrients and other products can promote overall well-being, potentially aiding in skin health, hair growth, mental clarity, and improved sleep quality.

10. Potential for Improved Mental Health: Some vitamins and nutrients and other products can support brain function and neurotransmitter activity, which might contribute to better mental health, reduced symptoms of depression or anxiety, and improved mood stability.

Risks and Side Effects:

1. Injection Site Reactions: One of the most common side effects is pain, swelling, redness, or itching at the injection site. This may be temporary but can cause discomfort.

2. Allergic Reactions: Some individuals may have allergic reactions to components in the injection, leading to symptoms like rashes, hives, swelling, difficulty breathing, and anaphylaxis, which can be life-threatening.

3. Infection: Improper injection technique or non-sterile equipment can introduce bacteria, potentially leading to infections. These infections might be localized at the injection site or systemic.

4. Dosage Concerns: Overdosing or underdosing is possible. For some vitamins and minerals, taking too much can have detrimental effects on the body, ranging from minor symptoms like diarrhea to more serious ones like nerve damage or organ failure.

5. Hematoma or Bleeding: If the needle hits a blood vessel, it might cause bleeding or a hematoma (a collection of blood) at the injection site.

6. Embolism: Rarely, if air or a small fragment is introduced into the bloodstream, it can lead to an embolism, which can be life-threatening.

7. Nerve Damage: If the injection is administered incorrectly, it might cause damage to nearby nerves, leading to numbness, tingling, or pain.

8. Systemic Side Effects: Depending on the nutrient or vitamin, there may be systemic side effects like nausea, dizziness, headaches, or flu-like symptoms.

9. Interactions with Other Medications: The injected substances might interact with other medications the patient is taking, altering their effectiveness, or causing unintended side effects.

10. Tissue Damage: Repeated injections in the same area can lead to tissue damage or necrosis, especially if the injected substance irritates the tissue.

11. Dependency: Some patients may become dependent on the perceived benefits of their injections, leading to overuse or over-reliance on the treatment for well-being.

12. Discoloration: In some cases, the injection can cause a discoloration of the skin, either due to the substance itself or due to small amounts of blood leaking into surrounding tissues.

Alternatives:

1. Oral Supplements: One of the most common alternatives is taking vitamins and nutrients and other products orally in the form of pills, capsules, or liquids. This method is non-invasive and widely available but may have lower bioavailability compared to injections.

2. Topical Applications: Some vitamins and nutrients and other products can be applied directly to the skin in the form of creams, gels, or patches. This method allows for localized treatment but might not be suitable for systemic needs.

3. Sublingual and Buccal Administration: These methods involve placing a drug under the tongue (sublingual) or between the gums and cheek (buccal) where it can be absorbed directly into the bloodstream, offering a more rapid onset than oral ingestion.

4. Intranasal Sprays: Some nutrients can be administered as nasal sprays. This method allows the substance to be absorbed through the mucous membranes in the nose, bypassing the digestive system.

5. IV Drips: Intravenous (IV) drips can be used to deliver vitamins and nutrients and other products directly into the bloodstream over a more extended period. This method ensures 100% bioavailability, much like auto-injections, but takes longer and usually requires a clinical setting.

6. Dietary Changes: Increasing the intake of foods rich in the required vitamins and nutrients

and other products can be an alternative. This method is natural but may require significant dietary adjustments and might not provide sufficient amounts for those with severe deficiencies.

7. Powders and Drink Mixes: Some vitamins and nutrients and other products are available in powder form that can be mixed with water or other beverages. This can be a palatable and convenient alternative for those who dislike pills.

8. Suppository: Certain vitamins and nutrients and other products can be administered rectally or vaginally via a suppository. This allows for direct absorption into the bloodstream, bypassing the digestive system.

9. Pellet Therapy: This involves implanting a small pellet under the skin, which slowly releases the required vitamins or hormones over time. It's less invasive than regular injections and offers prolonged benefits.

10. Transdermal Patches: These patches, worn on the skin, release a steady amount of the vitamin or nutrient over time, allowing for consistent dosing without the need for daily administration.

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Informed Consent for Testosterone Replacement Therapy u other hormone imbalance correction (When Applicable).

I hereby give my consent to the evaluation and treatment by Leonel Cordova. MD/ DrVitaminIV, LLC. and any other provider associated with DrVitaminIV, LLC. for the following specified condition(s):

Andropause or associated symptoms (Including testosterone replacement, manipulating hormone levels including DHEA and estradiol). Growth hormone abnormalities include decreased or suboptimal IGF -1 and decreased or suboptimal Vitamin D-3 levels. Nutritional deficiencies, Overweight/Obesity, B12, injections, and anything else the medical provider deems necessary.

In addition:

I acknowledge that treatment with testosterone, growth hormone stimulators, bioidentical hormone replacement therapy, B12, NAD+, Semaglutide, Tirzepatide, and Thyroid optimization among others offered in this platform is considered an off-label use of the associated medications and have not been FDA-approved for the use of health optimization, wellness, weight loss and/or for anti-aging purposes unless there is a true medical necessity.

I agree to the administration of hormone replacement therapy, and/or nutritional supplements, and/or drugs designed to alter hormone levels which will meet my specific treatment objectives and to treat any specific diagnoses I might have.

I hereby authorize Leonel Cordova, MD, and additional staff to evaluate me for admission into the DrVitaminIV, LLC. for non-medically needed, non-FDA-approved treatments that might improve my quality of life accordingly. I consent to obtain blood work before treatment if deemed necessary. I certify that I am signing this under my free will and am competent to make my own medical decisions.

I have reviewed the mentioned risks and have determined the benefits outweigh the possible risks associated with therapies with Leonel Cordova, MD/ DrVitaminIV, LLC., I release any claim in court or any type of complaint that could result from treatment with Leonel Cordova, MD/ DrVitaminIV, LLC. and any other staff associated and will not hold liable any provider or staff of Leonel Cordova, MD/ DrVitaminIV, LLC.

I understand the treatment modalities utilized by Leonel Cordova, MD/ DrVitaminIV, LLC. might not be supported by scientific/medical literature and could be seen as experimental or based on anecdotal claims. Many medical providers, including endocrinologists, surgeons, family practice doctors, etc., might see these types of treatments as not medically necessary. I also understand that many of the medications are being utilized within Leonel Cordova, MD/ DrVitaminIV, LLC. medically managed weight loss programs are considered to be used “off-label” and might not be FDA-approved for weight loss purposes.

I acknowledge that I have had the opportunity to discuss any concerns and to fully understand in detail the above information, with Leonel Cordova, MD/ DrVitaminIV, LLC., either in person or by telephone/videoconference/or other HIPAA-compliant means of communication. I consent to the treatment being offered to me by Leonel Cordova, MD/ DrVitaminIV, LLC. and I am satisfied with the explanation. I acknowledge that I have read or have read to me the above and understand the information presented.

Alternative Treatments to Testosterone Replacement I have been informed about alternative treatments and understand:

1-That we can leave the hormone levels alone.

2-We can use a natural approach such as weight loss and nutrition instead.

3-We can use alternative medications to increase your testosterone levels vs. using prescription testosterone

Safety of Hormone Replacement

Available data supports the safety of testosterone replacement therapy in men, and it is the opinion of Leonel Cordova, MD/ DrVitaminIV, LLC. that treatment is safe, but there remains controversy regarding the correlation between the use of testosterone replacement therapy and cardiovascular events such as but not limited to strokes, heart attacks, and blood clots. Some studies have shown correlations between testosterone replacement therapy and cardiovascular disease while others show no correlation or even a benefit in preventing cardiovascular disease.

I understand that close monitoring is required by all patients to minimize and prevent any possible risks. I understand that Leonel Cordova, MD/ DrVitaminIV, LLC. will monitor my blood work including hormone levels. I also understand that it is important to stay up to date with routine screening and health maintenance by my primary care provider to prevent and detect any possible life-threatening diseases or conditions.

I agree to obtain and remain up to date on all age-appropriate screenings including, but not limited to, digital rectal exams, colonoscopies, cardiac screenings, and any other type of recommended health screenings. I agree to obtain these screenings through the direction of my primary care provider and will not hold Leonel Cordova, MD/ DrVitaminIV, LLC. or any additional DrVitaminIV, LLC. staff responsible or liable for performing these health maintenance screenings or the treatment of any other conditions not relevant to my treatment goals with DrVitaminIV, LLC.

I want to initiate treatment at DrVitaminIV, LLC. and I give permission to Leonel Cordova, MD/ DrVitaminIV, LLC. and additional staff of DrVitaminIV, LLC. to begin treatment without knowing the results of age-appropriate and health maintenance screenings. In doing so, I release Leonel Cordova, MD/ DrVitaminIV, LLC. and other healthcare practitioners of any claims of liability for cardiovascular events, prostate cancer, breast cancer, testicular cancer, and/or colon cancer. Further, I agree to immediately notify Leonel Cordova, MD/ DrVitaminIV, LLC., and additional staff of DrVitaminIV, LLC. of any abnormal findings on any health screenings done by my primary care provider.

I acknowledge that remains controversy regarding the correlation between the use of testosterone replacement therapy and cardiovascular events such as but not limited to strokes, heart attacks, and blood clots. Some studies have shown correlations between testosterone replacement therapy and cardiovascular disease while others show no correlation or even a benefit in preventing cardiovascular disease.

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PATIENT ACKNOWLEDGMENT AND AGREEMENT OF NURSES PROVIDING SERVICES AS INDEPENDENT CONTRACTORS AT HOME OR ANY OTHER SELECTED PLACE BY PATIENT.

WHEREAS, Leonel Cordova, MD/ DrVitaminIV, LLC. facilitates access to independent nursing contractors (“Nurses”) who provide intravenous (IV), Intramuscular (IM), or Subcutaneous (SQ) therapy services including placement, medication administration, documentation, management of side effects, and other related services (“Services”) at the location chosen by the Patient; and whereas the Patient understands and agrees that the Nurses are independent contractors and not employees or agents of the Leonel Cordova, MD/ DrVitaminIV, LLC.

NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the parties agree as follows:

1- INDEPENDENT CONTRACTORS. The Patient acknowledges that the Nurses are independent contractors and are neither employees nor agents of Leonel Cordova, MD/ DrVitaminIV, LLC. The Nurses carry their own professional malpractice insurance and are solely responsible for the Services they provide.

2- SELECTION OF NURSES. The Patient may select a Nurse from a list provided by Leonel Cordova, MD/ DrVitaminIV, LLC., and may independently contract with a nurse of their choosing. In either case, the contractual relationship for Services is directly between the Patient and the Nurse.

3- COMPENSATION: The Patient understands that the Nurses receive a flat fee for their services, which include but are not limited to IV placement, IV-IM-SQ medication administration, visit and procedure documentation, report, and management of side effects. Compensation for the Services rendered by the Nurses shall be remitted directly to the nurses by the Patient prior to the commencement of the Services. Alternatively, at the discretion of the parties involved, such compensation may be collected by Leonel Cordova, MD/ DrVitaminIV, LLC. on behalf of the Nurses. In this event, all funds received for compensating the Nurses will be remitted to them via electronic transfer, check, or any other mutually agreed-upon payment between the nurses and Leonel Cordova, MD/ DrVitaminIV, LLC. This arrangement shall be subject to the terms of a separate agreement between the Nurses and Leonel Cordova, MD/ DrVitaminIV, LLC., outlining the specifics of the payment processing, including any applicable service fees or charges.

4- PHYSICIAN'S STANDING ORDERS: The Nurses will perform the Services in accordance with the standing orders, medications, and supplies provided by Leonel Cordova, MD/ DrVitaminIV, LLC.

5- LIMITATION OF LIABILITY: The Patient acknowledges that the Provider is not responsible for any adverse effects, negligence, or mismanagement that may arise from the Services provided by the Nurse. The Patient agrees to hold Leonel Cordova, MD/ DrVitaminIV, LLC. harmless from any claims, damages, or liabilities arising from the Nurse's acts or omissions.

6- GOVERNING LAW. This Agreement shall be governed by and construed in accordance with the laws of Florida.

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Acknowledgment of Non-Medical Necessity and Use of "Off Label" Non-FDA Approved Medication:

1. Understanding of "Off-Label" Use: I recognize that the term "off-label" refers to the use of an FDA-approved medication for purposes or in dosages not specified in the official label. While the FDA may not have reviewed or approved this use, some clinicians find it beneficial in their medical judgment.

2. Absence of Medical Necessity: I understand that this medication or treatment, while potentially beneficial, is not deemed a "medical necessity." This implies that the treatment is not essential for the maintenance of my health, nor is it primarily targeted at curing, diagnosing, or alleviating a specific health condition.

3. Previous Patient Experiences: I acknowledge that while this "off-label" medication has not been approved by the FDA for this particular use, it has been well-tolerated by some patients who have reported positive outcomes. However, it's essential to recognize that individual responses can vary, and what works for one person might not work for another.

4. Potential Risks and Benefits: I am aware that all medications, whether FDA-approved for a specific use or not, come with potential risks and benefits. I have been informed about the known risks and potential benefits of this "off-label" use and have had the opportunity to discuss them in depth with my healthcare provider.

5. Informed Decision: By choosing to proceed with this treatment, I am doing so based on the information provided, my understanding of the potential benefits, and the risks involved. I am making an informed decision, understanding that while many have found benefits, there are no guarantees of similar results.

6. Continuous Monitoring: I acknowledge the importance of being under regular supervision while using this medication. I will promptly report any unusual or adverse reactions to my healthcare provider and remain open to discussing alternative treatments if necessary.

I understand the treatment modalities utilized by Leonel Cordova, MD/ DrVitaminIV, LLC. might not be supported by scientific/medical literature and could be seen as experimental or based on anecdotal claims. Many medical providers, including endocrinologists, surgeons, family practice doctors, etc., might see these types of treatments as not medically necessary. I also understand that many of the medications are being utilized within Leonel Cordova, MD/ DrVitaminIV, LLC. medically managed to improve quality of life and are used “off-label” and might not be FDA-approved for the intended purposes.

I accept and agree with all the above. I acknowledge that I have had the opportunity to discuss any concerns and to fully understand in detail the above information, with Leonel Cordova, MD/ DrVitaminIV, LLC., either in person or by telephone/videoconference/or other HIPAA-compliant means of communication. I consent to the treatment being offered to me by Leonel Cordova, MD/ DrVitaminIV, LLC. and I am satisfied with the explanation. I acknowledge that I have read or have read to me the above and understand the information presented.

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Indemnification Clause

I agree to indemnify, defend, protect, and hold harmless the medical providers employed by Leonel Cordova, MD/ DrVitaminIV, LLC.; and their respective officers, directors, employees, stockholders, assigns, successors, and affiliates (Indemnified Parties) from, against, and in respect of all liabilities, losses, claims, damages, judgments, settlement payments, deficiencies, penalties, fines, interest, and costs, expenses suffered, sustained, incurred or paid by the indemnified parties, in connection with, results from or arising out of, directly or indirectly, the medical providers employed by Leonel Cordova, MD/ DrVitaminIV, LLC.; rendering medical care, services, advice, and/or treatment, my failure to disclose all relevant information regarding my medical and physical condition, acts or omissions, the medical providers employed by Leonel Cordova, MD/ DrVitaminIV, LLC.; harm or injury resulting from medical care or pharmaceuticals provided directly or indirectly by the medical providers employed by Leonel Cordova, MD/ DrVitaminIV, LLC.; I am aware of the potential side effects and outcomes associated with Medical Weight Management Therapy, Hormone replacement therapy, IV infusion, injectable therapies, and other treatments provided by Leonel Cordova, MD/ DrVitaminIV, LLC. I accept all the risks involved, and I will not seek indemnification or damages from the indemnified parties.

I accept and agree with all the above. I acknowledge that I have had the opportunity to discuss any concerns and to fully understand in detail the above information with Leonel Cordova, MD/ DrVitaminIV, LLC/ Nurse Independent Contractor., either in person or by telephone/videoconference/or other HIPAA-compliant means of communication. I am satisfied with the explanation. I acknowledge that I have read or have read to me the above and understand the information presented.

Practice Policies

If you have any questions, please feel free to ask us. Please initial each point acknowledging you understand that:

Services must be paid for at the time of service.

We do not accept Health insurance. This is a Cash based practice. Credit Cards are accepted. We do not work with, provide, or dispense controlled substances. I agree to follow my medical provider's instructions. I also agree that I will not sell or share my prescriptions with other individuals.

I understand that treatments provided by Leonel Cordova, MD/ DrVitaminIV, LLC. might not be considered a medical necessity. Treatments rendered are to improve your quality of life through hormone restoration, nutritional and supplemental counseling, and weight loss treatment.

I agree that if I have any side effects or become sick, I will follow up with my primary care provider or go to an urgent care or emergency department.

I acknowledge that Leonel Cordova, MD/ DrVitaminIV, LLC., is not my primary care provider. I agree that I will continue with routine care through my primary care provider and notify them of treatments prescribed at Leonel Cordova, MD/ DrVitaminIV, LLC.

I understand that there are no refunds for services or products rendered. We cannot accept back used medications once they have been dispensed per state regulation.

I understand that having an appointment with Leonel Cordova, MD/ DrVitaminIV, LLC. does not necessarily entitle me to be issued a prescription for hormone replacement, weight loss medication, or additional medications. Every individual is different, and it is at the medical provider's discretion to issue a prescription.

I understand that I must maintain my follow-up appointments to remain on treatment. It is important that lab work is monitored regularly for safety purposes. It is important that Leonel Cordova, MD/ DrVitaminIV, LLC. manages my treatment, and it is at their discretion to provide.

I acknowledge that I have been advised of the risks and benefits of treatment. I also acknowledge that I have been advised of possible complications and side effects. I understand the risks, benefits, complications, and side effects of treatment.

I am voluntarily requesting treatment with Leonel Cordova, MD/ DrVitaminIV, LLC. regarding weight loss therapy as determined by a mutual decision between myself and the medical provider even if my hormone levels are in the normal range for my age based on other medical society recommendations and guidelines or if I am just considered overweight and not obese.

I do not hold any medical practitioner of DrVitaminIV, LLC. responsible for performing age-related preventive care. I agree that I will follow up with my primary care provider to obtain these screenings and I hold Leonel Cordova, MD/ DrVitaminIV, LLC. harmless if an adverse event occurs during my treatment. I will ensure that my primary care provider provides the results of such screenings to Leonel Cordova, MD/ DrVitaminIV, LLC.as this could change the treatment prescribed to me.

Self-Administered Medication Agreement and Release of Liability:

I hereby confirm that I have thoroughly perused and comprehended the terms outlined in this release of liability document, and I willingly consent to its conditions. I acknowledge that this agreement constitutes a legally binding contract between myself and the released parties, nullifying any prior or contemporaneous agreements or understandings, regardless of whether they were verbal or written. I acknowledge that I have been provided with comprehensive instructions and educational materials pertaining to the administration of injections at home. I am aware that the potential risks associated with injections have been discussed with me, encompassing but not limited to localized and generalized reactions, skin rashes, bruises, and other possible effects. If I choose to self-administer the injections or have a designated individual administer them to me, I understand that I must have the presence of a responsible adult for a minimum of 30 minutes, capable of providing assistance in case of a severe adverse reaction. - I agree to keep an epinephrine injector readily available in the event of a systemic reaction, or alternatively, I will promptly contact emergency services (911) for immediate management of any adverse reaction and transportation to the nearest emergency facility. Furthermore, I commit to informing Leonel Cordova, MD/ DrVitaminIV, LLC. without delay if I experience any adverse reactions or side effects that may be related to the prescribed medications. I acknowledge that I have received comprehensive instructions on the proper usage and administration of the medication. Additionally, I understand that it is my responsibility to verify the expiration date of the medication, and if it is expired, I will promptly seek a renewal. - I acknowledge that it is incumbent upon me to schedule and attend follow-up appointments with my physician as required. I fully assume responsibility for receiving the injections and release the Physician from any liability or accountability for any reactions, medical conditions, self-injection procedures, or injuries that may arise in connection with the injection therapies.

I accept and agree with all the above. I acknowledge that I have had the opportunity to discuss any concerns and to fully understand in detail the above information with Leonel Cordova, MD/ DrVitaminIV, LLC., either in person or by telephone/videoconference/or other HIPAA-compliant means of communication. I am satisfied with the explanation. I acknowledge that I have read or have read to me the above and understand the information presented.

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Release of Liability for Misuse of Prescribed Medication:

I hereby acknowledge that I have received a prescription for medication from a Physician, who has duly informed me about the potential risks associated with the misuse of prescribed medication. I am fully aware that the misuse of the prescribed medication(s) can give rise to various risks, including but not limited to allergic reactions, side effects, and adverse interactions with other medications. I hereby release and discharge the prescribing physician, the pharmacy responsible for filling my prescription, and all other parties involved in the prescription and distribution of my medication, from all claims, damages, losses, or injuries that may arise as a result of my misuse of the medication. This release encompasses claims related to negligence, strict liability, breach of warranty, or any other legal theory. I understand that this release also extends to claims for personal injury, property damage, or economic loss that may arise from my misuse of the medication. I acknowledge that I bear sole responsibility for any consequences that may ensue from my misuse of the medication, which includes using it beyond the expiration date or beyond the recommended duration of use, administering an insufficient dose, or deviating from the prescribing physician's instructions in any manner. Furthermore, I agree to indemnify and hold harmless the prescribing physician, the pharmacy responsible for filling my prescription, and all other parties involved in the prescription and distribution of my medication, from all claims, damages, losses, or injuries that may arise because of my misuse of the medication, including claims asserted by third parties. I acknowledge that I have read and understood the terms of this liability release for the misuse of prescribed medication and voluntarily agree to its conditions.

I accept and agree with all the above. I acknowledge that I have had the opportunity to discuss any concerns and to fully understand in detail the above information with Leonel Cordova, MD/ DrVitaminIV, LLC., either in person or by telephone/videoconference/or other HIPAA-compliant means of communication. I am satisfied with the explanation. I acknowledge that I have read or have read to me the above and understand the information presented.

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Consent Form for Credit Card Charges:

I hereby grant authorization to Leonel Cordova, MD/ DrVitaminIV, LLC. to charge my credit card for the requested services and products, as well as any relevant fees or charges associated with said services and products. Furthermore, I authorize you to make recurring charges to my credit card for any subscriptions or ongoing services that I have agreed to, in accordance with the specified frequency stipulated at the time of purchase. I am fully aware that I possess the right to cancel or modify these charges at any given time by contacting Leonel Cordova, MD/ DrVitaminIV, LLC. I understand that such cancellation or modification may result in the termination of services or Leonel Cordova, MD/ DrVitaminIV, LLC. that I have requested or subscribed to. I comprehend that it is my responsibility to ensure the accuracy and currency of my credit card information. Hence, I pledge to promptly notify [of any changes to my credit card details. I acknowledge that my credit card information will be securely stored and handled in strict compliance with applicable laws and regulations. I understand that this information will solely be used for the purposes delineated in this consent form. I affirm that I have diligently read and comprehended the terms set forth in this consent form. Moreover, I willingly agree to the credit card charges and automatic recurring payments as described above.

Refund Policy:

Please be advised that all products offered by our organization are non-refundable. We would like to emphasize that medications and home kits are specifically ordered for each individual patient and, as a result, cannot be refunded. Therefore, we strictly adhere to a 'no refund policy' regarding purchases. Once a vial of medication is initiated, you may continue to use it until the expiration date specified on the vial itself, within the time frame recommended by CDC. For recurring subscriptions, it is important to note that they are billed on a monthly or yearly basis as agreed when purchased, and with charges occurring on the same day each month or year accordingly. To cancel a subscription, we kindly request that you contact us at: https://www.drvitaminiv.com/contact providing your name, date of birth, and a request for cancellation. However, please be aware that once a subscription has been billed, it cannot be canceled or refunded. All medications have an expiration date ranging from 1 to 4 months (although this may vary for each medication). After the expiration date, the medication is considered expired and must be discarded. Please note that packages and vials cannot be used once they have expired. I confirm that I have read and fully understood the terms of this refund policy. I am aware that all products offered are non-refundable, and I agree to abide by these conditions.

Acknowledgment of Malpractice Insurance Status:

You are aware that Leonel Cordova, M.D. / DrVitaminIV does not carry traditional malpractice insurance as permitted under Florida law.

Protection by Law Firm: Instead, Leonel Cordova, M.D. / DrVitaminIV is fully covered and protected by a Medical Malpractice Law Firm operating in Florida (Lubell Rosen, LLC), ensuring a level of accountability and recourse in the unlikely event of medical malpractice.

Informed Decision: Your decision to receive care and treatment from Leonel Cordova, M.D. / DrVitaminIV is made with full awareness of the malpractice insurance status. You understand that this does not diminish the quality of care provided but is a legal alternative to traditional malpractice insurance coverage.

Consent to Proceed: Understanding the above information, you consent to proceed with receiving care and treatment under the terms outlined by Leonel Cordova, M.D. / DrVitaminIV. You acknowledge that this consent is part of your informed decision to engage in treatments and services offered.

Questions and Concerns: You affirm that any questions or concerns regarding the malpractice insurance status and protection through a law firm have been addressed to your satisfaction.

You confirm that you have read, understood, and acknowledge the malpractice insurance status of Leonel Cordova, M.D. / DrVitaminIV as described above. You agree to proceed with treatments and services, fully informed of this aspect of the practice.

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My Obligations and Representations

Any questions I have regarding this treatment have been answered to my satisfaction. I understand that I will be responsible for administering the medications prescribed to me if I do not have them administered to me in the clinic. I also promise to comply with the dosages and frequency of medications prescribed to me.

I certify that I am under the regular care of a primary care provider for any other conditions I might have or am found to have. I will consult with my primary care provider or specialist regarding any other condition I might have. I understand that if I do not have a primary care provider, I will be encouraged to seek one out. I acknowledge that I am seeking care at DrVitaminIV, LLC. for medically managed weight loss services DrVitaminIV, LLC. offers. I acknowledge I do not want to establish primary care with DrVitaminIV, LLC. and I am here for specialized care including weight loss therapy, diet counseling, exercise counseling, (additional services you have), etc.

I accept and agree with all the above. I acknowledge that I have had the opportunity to discuss any concerns and to fully understand in detail the above information with Leonel Cordova, MD/ DrVitaminIV, LLC., either in person or by telephone/videoconference/or other HIPAA-compliant means of communication. I am satisfied with the explanation. I acknowledge that I have read or have read to me the above consent and understand the information presented.

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