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Medical Screening Questions
Please answer all questions honestly. This information is crucial for your safety.
Do you currently have a diabetes diagnosis?
Have you previously used GLP-1 medications?
Do you have a history of pancreatitis?
Do you have a family history of thyroid cancer?
Are you currently pregnant or breastfeeding?
Do you have a history of eating disorders?
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Information Acknowledgment
About Mounjaro Injection
Mounjaro (tirzepatide) is a prescription medication used for weight management in adults with obesity or overweight with weight-related medical problems. It works by mimicking hormones that regulate blood sugar and slow gastric emptying, leading to reduced appetite and food intake.
Common Side Effects
- Nausea and vomiting
- Diarrhea or constipation
- Decreased appetite
- Abdominal pain
- Fatigue
- Injection site reactions
Serious Risk Warnings
- Thyroid tumors, including cancer
- Pancreatitis (inflammation of the pancreas)
- Severe allergic reactions
- Kidney problems
- Severe low blood sugar
- Gallbladder problems
Expected Benefits
- Significant weight loss (average 15-20% of body weight)
- Improved blood sugar control
- Reduced appetite and food cravings
- Potential cardiovascular benefits
- Improved quality of life
Individual results may vary. Benefits are typically seen with consistent use alongside a healthy diet and exercise program.
Emergency Warning Signs
- Severe abdominal pain that won't go away
- Severe nausea and vomiting
- Signs of allergic reaction (rash, difficulty breathing, swelling)
- Signs of low blood sugar (shakiness, sweating, confusion)
- Severe dehydration
- Unusual lumps or swelling in the neck
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Responsibility Declaration & Signature
Important Declaration
By proceeding with this treatment, I acknowledge that I have read, understood, and accept full responsibility for my treatment with Mounjaro injection. I understand the risks, benefits, and potential side effects. I commit to contacting my GP or seeking emergency medical care if I experience any adverse effects or concerning symptoms.
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