INJECTABLES INFORMED CONSENT
Vitamin Injections common side effects include but are not limited to:

I. Risks: I understand there is risk of mild diarrhea, upset stomach, nausea, a feeling of
irritation/warmth at the site of the injection.

2. I understand that although rare, Vitamin injections can result in serious side effects.

Although this is a relatively rare occurrence, anyone taking vitamin B 12 injections should be aware of the possibility. These should be reported to your personal physician or walk in urgent care clinic immediately:

• Rapid heartbeat /chest pain/ tightness
• Difficulty breathing and swallowing/shortness of breath
• Dizziness/confusion
• Hives, skin rashes
By checking this box, I acknowledge that I have read this infom1ed consent and agree to the injections. I give consent to perform this and all subsequent VITAMIN Injections. I hereby release the doctor, the person injecting the YIT A MINS and the facility from liability associated with this procedure.
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