PEPTIDE PROTOCOL CONSENT FORM

Kanaklyx LLC

CLIENT INFORMATION

Name: _______________________________

Date of Birth: _______________________________

Client Reference Number (if applicable): _______________________________

TREATMENT OVERVIEW

This document provides detailed information about peptide therapy, its potential benefits and risks, and your rights as a client. Please review this information carefully before deciding whether to consent to this treatment protocol with the Kanaklyx team.

DESCRIPTION AND NATURE OF PEPTIDE THERAPY

Peptides are naturally occurring short chains of amino acids that serve as building blocks for proteins in the body. Therapeutic peptides are specifically formulated compounds that may support various physiological functions. Peptide therapy is offered by Kanaklyx as part of a health and wellness program focused on optimizing physiological function, supporting cellular repair mechanisms, and potentially promoting longevity and well-being.

REGULATORY STATUS

The client acknowledges and understands the following regarding the regulatory status of peptide therapy:

• Many peptides are classified as research compounds by regulatory authorities.
• Only certain peptides may have formal approvals for specific indications.
• Some peptides may be used in “off-label” applications.
• Off-label application is for research purposes only and not made for human consumption.

The specific peptide(s) selected is/are:

• □ Approved for this specific indication (if applicable)
• □ Approved but being used for a non-approved indication (off-label use)
• □ Not approved (research/investigational compound)
• □ Compounded peptide preparation

POTENTIAL BENEFITS

Possible benefits from peptide therapy may include:

• Enhanced cellular repair and regeneration
• Improved immune system function
• Increased energy and vitality
• Improved sleep quality
• Enhanced recovery from physical activity or stress
• Support for metabolic function
• Potential anti-aging and longevity effects
• Other: _______________________________

It is important to understand that individual responses to peptide therapy vary considerably. Results are not guaranteed, and the extent of benefits may differ among individuals based on genetics, lifestyle, concurrent therapies, and overall health status.

RISKS AND POTENTIAL SIDE EFFECTS

Peptide therapy carries potential risks and side effects, which may include but are not limited to the following:

Common Side Effects:

• Injection site reactions (redness, irritation, pain, or swelling)
• Mild headache
• Temporary water retention
• Temporary joint pain or discomfort
• Flushing or warmth sensation
• Temporary changes in blood pressure
• Fatigue or lethargy
• Nausea

Less Common Side Effects:

• Allergic reactions
• Changes in heart rate
• Numbness or tingling sensations
• Dizziness
• Changes in blood glucose levels
• Gastrointestinal disturbances
• Changes in mood or energy levels

Rare but Serious Side Effects:

• Severe allergic reactions including anaphylaxis
• Significant changes in blood pressure
• Abnormal tissue growth or development
• Hormonal imbalances
• Unexpected interactions
• Other unpredictable adverse reactions

Long-Term Risks:

• Some long-term risks remain unknown, as certain peptides have limited long-term safety data.
• Potential for unpredicted long-term complications.
• Possibility of desensitization with prolonged use.

ALTERNATIVES TO PEPTIDE THERAPY

Alternative approaches to achieve similar wellness objectives may include:

• Lifestyle modifications (diet, exercise, sleep hygiene, stress management)
• Nutritional supplementation
• Other wellness or performance-support approaches
• Electing not to pursue peptide therapy

STORAGE, HANDLING, AND ADMINISTRATION GUIDELINES

For optimal safety and effectiveness of selected peptide(s), you agree to:

• Store peptides according to specific instructions (typically refrigerated, if applicable).
• Follow all proper instructions and procedures.
• Use appropriate administration techniques as instructed.
• Maintain sterile conditions for injectable peptides.
• Dispose of needles and related waste properly.
• Follow the selected dosage and schedule exactly as directed.

POST-TREATMENT EXPECTATIONS AND FOLLOW-UP

Following initiation of peptide therapy:

• Effects may not be immediate and may develop gradually.
• Desired outcomes may require consistent use over time.
• Follow-up check-ins may be recommended to monitor response.
• Adjustments to your protocol may be suggested based on your individual response.

Scheduled follow-up: _______________________________

COST INFORMATION

Estimated cost of the selected peptide therapy: $ _______________________

• Payment is typically required at the time of service or prior to dispensing.
• Additional costs may apply for follow-up consultations and monitoring.
• You are personally responsible for all costs related to this therapy.

TERMS AND CONDITIONS

• No Refunds or Exchanges: There are no refunds, returns, or exchanges for peptide products or related services, regardless of outcome.
• No Guaranteed Results: Results are not guaranteed and may vary significantly between individuals.
• Voluntary Participation: You are choosing to undergo peptide therapy voluntarily and may decline or discontinue at any time.
• No Claims: Unless explicitly stated otherwise, peptide therapy is intended for wellness optimization and is not represented as a cure for any disease.

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.

INFORMED CONSENT AND ACKNOWLEDGMENTS

By proceeding with peptide therapy with the Kanaklyx team, you acknowledge and agree that:

• You have received complete information about peptide therapy, including potential benefits, risks, and alternatives.
• You have had an opportunity to discuss this program with your own physician and have had all questions answered.
• You understand that individual results are variable and results are not guaranteed.
• You accept that some aspects of peptide therapy may be investigational and that long-term effects may not be fully known.
• You have disclosed relevant health history, allergies, and considerations to the best of your knowledge.
• You will comply with all follow-up guidance and promptly report any adverse reactions.
• You understand the financial terms, including the no-refund policy for products already dispensed.
• You consent to the collection and use of treatment data for quality improvement and research purposes, with your privacy protected.
• You understand that you may discontinue at any time, though no refunds will be provided for products already dispensed.

AUTHORIZATION

By signing, you voluntarily consent to participate in the peptide therapy program as described in this document with Kanaklyx LLC.