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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.
Treatment Information:
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
- Nausea
- Vomiting
- Constipation
- Fatigue
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.
Date / Time
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Please follow the aftercare advice for intramuscular Vitamin D injection.

• You may experience some mild tenderness, redness and swelling around the
injection site. These effects will usually resolve within 48 hours but may last
longer in some cases.
• You may experience some bruising around the injection site, this will resolve
naturally but may take 1-2 weeks to resolve.

• If you experience any discomfort afterwards you can take a simple over the
counter painkiller such as paracetamol.
• You must seek medical attention and contact your practitioner if you develop
any signs or symptoms of skin infection around the injection site. Infection can
present as hot, red shiny skin, there may be pus formation and you may have
a fever or feel generally unwell.

• You must contact your practitioner as soon as possible if you experience any
other unwanted side effects after having the injection.
• Seek medical attention if you feel unwell or experience any significant side
effects following the injection.
• Seek emergency medical attention in the rare event that you experience any
severe allergy signs or features of anaphylaxis after the injection. These may
include rash, facial swelling and breathing difficulties.
It is essential that you have read all of the information available. Once you have read
and understood all of the below, please sign the declaration at the bottom of this form.
Please do let your practitioner know if you have any questions or if you do not
understand any of the aftercare instructions provided below.
I confirm that I have read and understood all the information on this Form and that I
have been given the opportunity to ask any questions that have come to mind