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Consent Form

Please complete this consent form before your Vitamin Injections (B12, B Complex, Vitamin C, D, Biotin, Glutathione) appointment. Once you sign, a copy is emailed to you and to Gemma automatically.

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Vitamin Injections (B12, B Complex, Vitamin C, D, Biotin, Glutathione) — treatment information & disclaimer

Vitamin injections deliver vitamins (such as B12, B Complex, Vitamin C, Vitamin D, Biotin and Glutathione) by intramuscular injection to support energy, wellbeing and skin. They are not a substitute for medical care or a balanced diet, and are not intended to diagnose, treat or cure any medical condition. If you suspect a vitamin deficiency you should see your GP. Where required, injectable products are prescribed following a separate consultation.

Common side effects include pain, redness, swelling, soreness and bruising at the injection site lasting a few days, and feeling faint. Uncommon side effects include dizziness, headache, nausea, hot flushes, skin reactions and insomnia.

Rare side effects include allergic or anaphylactic reaction requiring emergency care. Glutathione is not given during chemotherapy. Please tell your practitioner immediately if you feel unwell during or after the injection.

A non-refundable deposit is required to secure your appointment. The balance is payable at your appointment. Deposits and booking fees are non-refundable unless agreed with the practitioner.

Medical screening

Please answer honestly — this keeps your treatment safe. Add detail in the notes where relevant.

1. Are you pregnant, breastfeeding, or trying to get pregnant?
2. Do you have any medical conditions? If yes, please give details.
3. Are you taking any medication (including blood thinners such as Warfarin/Aspirin)? If yes, please list.
4. Do you have any allergies, or have you ever had anaphylaxis? If yes, please give details.
5. Do you have any skin or neuromuscular disorders?
6. Do you have diabetes, an autoimmune disease, or a bleeding/clotting disorder?
7. Do you have a history of keloid or hypertrophic (raised) scarring?
8. Do you have any active infection, cold sores, or inflammation at the treatment area?
9. Have you had this or a similar treatment before? If so, did you have any problems?
10. What are your aims and motivations for the treatment / desired outcome? Please give details.
11. Is there any other medical or social history we should know? Please give full details.
12. Do you understand the information provided and feel it is sufficient for you to consent?
13. Has your consent been given freely?

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