NAD⁺ Injector Pen Therapy Consent
1) Treatment Description
You are being offered Nicotinamide Adenine Dinucleotide (NAD⁺) therapy administered via a multi-dose subcutaneous injector pen for self-administration as directed by your provider.
NAD⁺ is a naturally occurring coenzyme involved in cellular energy production, mitochondrial function, and metabolic processes. This therapy is often used in wellness and longevity settings to support energy, focus, and metabolic resilience.
Uses may be considered off-label. Scientific evidence continues to evolve, and individual results vary. This treatment is not intended to diagnose, treat, cure, or prevent any disease and does not replace ongoing medical care.
2) Purpose / Expected Benefits (Not Guaranteed)
Potential goals of NAD⁺ therapy may include:
- Support for cellular energy production
- Reduced fatigue
- Improved mental clarity and focus
- Support for metabolic and mitochondrial health
- General wellness optimization
- No specific outcomes or results can be guaranteed.
3) Administration & Dosing
NAD⁺ will be administered subcutaneously (under the skin) using a pre-filled injector pen as prescribed by your clinician. You will receive instructions regarding:
- Proper injection technique
- Dosing schedule
- Injection site rotation
- Safe needle disposal
- Storage requirements (typically refrigerated unless otherwise instructed)
You agree to follow the dosing and administration guidelines provided.
4) Reasonable Alternatives
Alternatives to NAD⁺ injector pen therapy include:
- No treatment / watchful waiting
- Lifestyle modification (nutrition, exercise, sleep optimization)
- Oral supplementation
- IV NAD⁺ infusion therapy
- Evaluation and treatment by your primary care provider or specialist
You understand you are not required to proceed with this therapy.
5) Risks, Side Effects & Potential Complications
Common side effects may include:
- Pain, redness, swelling, bruising, or tenderness at the injection site
- Warmth or flushing
- Nausea
- Headache
- Dizziness or lightheadedness
- Fatigue
- Palpitations
Less common but more serious risks include:
- Infection or abscess
- Allergic reaction (including anaphylaxis)
- Bleeding
- Nerve or tissue injury
- Changes in blood pressure or heart rate
- Shortness of breath
- Chest discomfort
- Fainting (syncope)
- Other unexpected reactions
Medication or supplement interactions are possible and not fully known. You must disclose all current medications, supplements, and medical conditions.
Seek immediate medical attention for severe symptoms.
6) Contraindications & Cautions
You should not receive NAD⁺ therapy if you have:
- A known allergy to NAD⁺ or any component of the formulation
- An active infection at the injection site
- Been medically advised to avoid injectable therapies
Use caution and discuss with your provider if you have:
- Bleeding disorders or use anticoagulants
- Uncontrolled hypertension
- Arrhythmias or significant heart disease
- Liver or kidney disease
- History of severe allergic reactions
- Are pregnant, trying to conceive, or breastfeeding
7) Privacy & Communication
Your health information will be handled in accordance with applicable privacy laws (HIPAA). Electronic communications (email/text) may carry privacy risks. Please avoid transmitting highly sensitive information via unsecured channels.
8) Financial Responsibility
I understand that NAD⁺ injector pen therapy is an out-of-pocket service and is not billed to insurance.
I understand the cost of the NAD⁺ injector pen is $449.
9) Acknowledgments & Consent
I have read and understand the information above, including the potential risks, benefits, and alternatives; I have had the opportunity to ask questions and received satisfactory answers; I agree to disclose all medical conditions, medications, and allergies; I understand that individual results vary and no specific outcome is guaranteed; I acknowledge that this therapy is elective and not emergency care; and I understand that I may withdraw my consent at any time prior to administration.