You are being offered vitamin B12 and/or lipotropic injections as part of a wellness and weight management protocol at Evercare Wellness, LLC. These injections may support your body’s natural energy production, metabolism, and fat processing.
• Vitamin B12 is an essential nutrient that plays a key role in red blood cell formation, neurological function, and energy metabolism.
• Lipotropic injections typically contain a combination of B12, methionine, inositol, choline, and sometimes other amino acids. These agents may help support fat metabolism and liver function.
Although many individuals report benefits such as increased energy, reduced fatigue, improved memory, and weight management support, it is important to understand that these injections are not a guaranteed treatment and are considered off-label when used for energy or weight loss enhancement without a documented B12 deficiency.
POTENTIAL RISKS AND SIDE EFFECTS
All medical treatments carry the potential for side effects, even when rare or mild. Most patients tolerate these injections well, but possible adverse effects include:
Vitamin B12 (Cyanocobalamin or Methylcobalamin) Side Effects
• Mild diarrhea or upset stomach
• Nausea
• Pain, swelling, or redness at the injection site
• Headache or joint discomfort
Uncommon but serious side effects may include:
• Rapid heartbeat or chest pain
• Flushing
• Muscle cramps or weakness
• Difficulty breathing or swallowing
• Hives, rashes, or allergic reactions
• Dizziness or confusion
• Rapid weight gain or facial swelling
• Wheezing or persistent coughing without exertion
If you experience any of the above symptoms, seek immediate medical attention or call 911.
Lipotropic Injection Side Effects
• Gastrointestinal upset (e.g., nausea, diarrhea)
• Fatigue or restlessness
• Elevated heart rate
• Increased urination or urinary urgency
• Injection site discomfort
MEDICAL HISTORY & DISCLOSURES
To reduce the risk of complications, I agree to inform Evercare Wellness, LLC of any current or past medical conditions, especially the following:
• Leber’s Disease (a hereditary eye condition; B12 may worsen optic nerve damage)
• Liver or kidney disease
• Folic acid or iron deficiency
• Cardiovascular conditions
• Allergies to medications, supplements, or preservatives (including sulfa)
• Any medications or treatments affecting bone marrow or red blood cell production
I also understand that there may be interactions between B12/lipotropic injections and certain medications or supplements, and I agree to provide a full and accurate medication list before beginning treatment.
OFF-LABEL USE DISCLOSURE
I understand that:
• The use of vitamin B12 and lipotropic injections for increased energy and weight loss in the absence of a documented deficiency is considered off-label.
• These treatments are not approved by the U.S. Food and Drug Administration (FDA) for these indications but are commonly used in wellness and aesthetic medicine.
PATIENT ACKNOWLEDGMENTS
By signing this form, I acknowledge the following:
1. I have had the opportunity to discuss the benefits, risks, and alternatives to B12 and/or lipotropic injections with my provider.
2. I understand the potential side effects and agree to contact Evercare Wellness, LLC immediately if I experience any symptoms of concern.
3. I have disclosed all relevant medical conditions, allergies, and current medications to the best of my knowledge.
4. I understand this treatment is elective and not a substitute for a balanced diet, exercise, or medical management of underlying conditions.
5. I understand that no guarantee has been made regarding the outcome or effectiveness of this treatment.
6. I release and hold harmless Evercare Wellness, LLC, its medical providers, and the individual administering the injection from any liability related to adverse reactions, known or unknown, arising from the procedure, except in cases of gross negligence or willful misconduct.
CONSENT TO TREAT
I have read and fully understand this informed consent form. I have had the opportunity to ask questions and have received satisfactory answers. I voluntarily consent to receive vitamin B12 and/or lipotropic injections from Evercare Wellness, LLC.