Vitamin D Injection Consent Form
This consent form is designed to provide a written confirmation of the discussions you have had with your healthcare provider regarding your treatment with Vitamin D injections.
Vitamin D is essential for bone health, immune system function, and overall well-being. Your healthcare provider has recommended Vitamin D injections because your current levels of Vitamin D are lower than what is considered healthy and oral supplementation might not be adequate in your situation.
Potential Risks and Side Effects:
While Vitamin D injection is generally considered safe, it's important to understand that it may cause side effects in some individuals. These may include but are not limited to:
- Pain, swelling, or redness at the injection site
In rare cases, high levels of Vitamin D can lead to a condition known as hypercalcemia, which can cause confusion, disorientation, and problems with heart rhythm.
I have been advised of the relevant information associated with this treatment and I confirm that I fully understand this advice. This includes advice about:
- the aims/motivations for having the procedure and the desired outcome
- the risks inherent in the procedure
- the risks inherent in refusing the procedure
- the risks specific to me
- the expected benefits of the treatment
- the potential disadvantages of the treatment
- alternative procedures and their pros and cons - including the option of no treatment at all
- any uncertainties about and the likelihood of success of the procedure
- any follow-up treatment that may be required
CLINICAL PHOTOS AND VIDEOS: I agree to and authorise the taking of clinical photographs and videos. I understand that these clinical photographs and videos will form part of and will be kept with my confidential medical records.
I have been asked what information I want and would need in order to make an informed decision. I have been given the opportunity to discuss my desired outcome fully in order for me to make an informed decision.
I certify that I have read the above consent and that I fully understand it. I have been given ample opportunity for discussion and all my questions have been answered to my satisfaction. No new information has become available that affects my decision to have the treatment or my decision to consent. I hereby consent to this procedure. This constitutes the full disclosure and supersedes any previous verbal or written disclosures.