INFORMED CONSENT FOR GLP RECEPTOR AGONIST PROGRAM

Kanaklyx LLC

This informed consent (“Consent Form”) is entered into between Kanaklyx LLC (“Provider”) and the undersigned client (“Client”). This Consent Form establishes the Client’s understanding and authorization to participate in a GLP receptor agonist program as part of their selected plan.

1. PROGRAM INFORMATION

Selected Compound/Protocol: _______________________________

• □ GLP-1 receptor agonist protocol
• □ Dual GIP/GLP-1 protocol
• □ Triple GIP/GLP-1/Glucagon protocol

Delivery Format:

• □ Injectable
• □ Oral
• □ Other: _______________________

Primary Objective:

• □ Blood sugar support
• □ Weight-management support
• □ Other: _______________________

Initial Dose: __________ Target Dose: __________ Titration Schedule: __________

Frequency and Duration: ____________________________

REGULATORY STATUS

• Some compounds may be used in off-label applications.
• Off-label application is for research purposes only and not made for human consumption.

2. PURPOSE AND MECHANISM OF ACTION

GLP receptor agonist protocols may work through one or more of the following mechanisms:

• GLP-1 Receptor Activation: May help regulate blood sugar, slow gastric emptying, suppress glucagon, and increase feelings of fullness by acting on appetite centers in the brain.
• GIP Receptor Activation: Some protocols target GIP receptors, supporting insulin response and complementing GLP-1 activity.
• Glucagon Receptor Activation: Triple agonist approaches also activate the glucagon receptor, potentially increasing energy expenditure and supporting greater weight reduction.

Potential benefits may include:

• Improved blood sugar support
• Weight reduction support
• Reduced cardiovascular risk markers
• Decreased appetite and increased feeling of fullness
• Potential improvement in metabolic parameters

3. RISKS AND POTENTIAL SIDE EFFECTS

The Client acknowledges understanding the following potential risks and side effects:

Common Side Effects (may affect more than 10% of clients):

• Nausea, vomiting
• Diarrhea or constipation
• Abdominal pain or discomfort
• Decreased appetite
• Indigestion/heartburn
• Fatigue
• Injection site reactions (for injectable forms)

Less Common Side Effects:

• Low blood sugar, especially with other therapies
• Headache
• Dizziness
• Mild increase in heart rate
• Belching or flatulence
• Gastroesophageal reflux symptoms

Rare but Serious Side Effects:

• Pancreatitis (inflammation of the pancreas)
• Gastroparesis (delayed stomach emptying)
• Bowel obstruction
• Gallbladder problems (including gallstones)
• Acute kidney injury
• Vision-related complications (in certain metabolic contexts)
• Hypersensitivity reactions

4. CLIENT ACKNOWLEDGMENTS

The Client agrees to:

• Provide a complete and accurate health history.
• Disclose if they have relevant history such as pancreatitis, gallbladder disease, kidney problems, or pregnancy/breastfeeding.
• Report any adverse reactions or unusual symptoms promptly.
• Follow the selected schedule and titration plan.
• Attend all scheduled follow-up appointments.
• Follow recommended dietary and lifestyle modifications.
• Inform their own healthcare providers about participation in this program.

5. COST INFORMATION

• Estimated cost per month: $ _____________________
• The Client acknowledges responsibility for payment of services under this program.

6. VOLUNTARY CONSENT

By signing, the Client confirms that:

• This Consent Form has been fully explained.
• All questions have been answered satisfactorily.
• No guarantees have been made regarding outcomes and results are not guaranteed.
• Consent is given voluntarily and without coercion.
• Alternative options have been discussed.

MEDICAL DISCLAIMER

• All treatments are provided based off of client evaluation.
• Individual results vary and results are not guaranteed.
• Always consult your own physician before administering any peptides.