1. Purpose and Nature of Treatment
I, the undersigned, voluntarily consent to receive Oral Liposomal GLP-1 Medication therapy
as prescribed by a licensed healthcare provider through Shed. I understand this treatment is
intended to support weight management, metabolic health, and related wellness goals.
I acknowledge that this medication is being offered to me at no cost as part of Shed’s
Oral Liposomal GLP-1 Early Access Program.
Participation in this program does not create an obligation to continue treatment beyond the
early access period, and I may choose to discontinue at any time.
2. Informed Consent and Acknowledgment of Risks
Common side effects:
I have been fully advised by my healthcare provider of the potential benefits and risks
associated with Oral Liposomal GLP-1 Medication therapy. I understand and acknowledge the
following:
- No Guarantee of Results: Results vary among individuals. There is no guarantee that I
will achieve weight loss or other desired outcomes.
Below are the most commonly reported side effects for two frequently prescribed GLP-1
therapies: Semaglutide (GLP-1 receptor agonist) and Tirzepatide (GLP-1 + GIP
receptor agonist)
Common side effects:
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Decreased appetite
- Abdominal discomfort
- Fatigue
- Headache
- Indigestion
- Injection site reactions
What to Know:
Gastrointestinal (GI) side effects—like nausea, vomiting, and bloating—are the most common
and are typically dose-related. This means they often appear or worsen after a dose increase
but tend to settle as your body adjusts over time.
Some patients also experience delayed gastric emptying, which can lead to a sensation of
prolonged fullness or bloating. You might not immediately recognize it as a side effect, but if
you’re feeling unusually full for hours after eating or noticing slower digestion, this could be why.
Serious but Rare Complications:
While uncommon, serious potential complications associated with GLP-1 medications include
pancreatitis, gallbladder problems, and elevations in kidney function tests. Patients should
promptly report severe abdominal pain, jaundice, significant changes in urination, or swelling to
their healthcare provider.
- Oral Formulation Risks: Because this is an oral liposomal formulation, I understand
that absorption and effectiveness may vary based on individual physiology and digestive
factors. There is a possibility the medication may not be effective for me. - Other Health Risks: I understand this therapy may require medical monitoring if I have
conditions such as thyroid disease, kidney or liver disease, gastrointestinal disorders, or
a history of pancreatitis. - Non-FDA Approval: I understand that this Oral Liposomal GLP-1 Medication is not
FDA approved. It is a compounded formulation prepared by a licensed pharmacy in
compliance with applicable state and federal compounding laws. Its safety, efficacy, and
quality may differ from those of FDA-approved GLP-1 drugs. - Voluntary Participation: I am participating voluntarily and may discontinue treatment at
any time.
3. Data Usage and Marketing
I understand that Shed may use information collected during my participation (including
progress metrics, survey responses, and program data) in aggregated and anonymized form for
research, product development, or marketing purposes. My individual identity will not be
disclosed, and no personally identifiable information or personal health information will be used
without my express and written consent.
4. Assumption of Risk
I knowingly and voluntarily assume all risks associated with the use of Oral Liposomal GLP-1
Medication and related treatment protocols. I understand that medical outcomes cannot be
guaranteed and that unforeseen complications may occur.
5. Limitation of Liability
To the fullest extent permitted by law, I release, discharge, and hold harmless Shed, its
partnered medical providers, employees, contractors, and affiliates from any and all claims,
liabilities, demands, damages, or causes of action arising out of or connected to my participation
in this program.
The total liability of Shed shall not exceed the total amount I have paid for the program,
regardless of cause or claim.
6. Acknowledgment and Acceptance
I acknowledge that:
- I have read and fully understand this waiver and informed consent form.
- I have had the opportunity to ask questions, which have been answered to my
satisfaction. - I understand the risks involved and voluntarily consent to participate.
- I agree to comply with medical instructions and report any adverse effects immediately.
- I have had sufficient time to review this agreement together with an attorney (if I so
choose), and have not relied upon any other representations–whether oral or
written–regarding this Agreement or its subject matter.
7. Governing Law.
This Agreement shall be governed by the laws of the State of Utah without reference to or
consideration of conflict of laws principles. Any disputes arising under this Agreement shall be
resolved in a court of competent jurisdiction within the State of Utah, Salt Lake County.
I hereby warrant that I am at least 18 years of age, or that if I am a minor that I have every right
to contract in my name in the above regard and have had my parent or guardian execute this
release. I further state that I have read this RELEASE prior to its execution, and that I am fully
familiar with its contents.
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