This informed consent and liability waiver outlines the purpose, benefits, potential risks, and conditions associated with the use of compounded medications for hair regrowth.

These medications include:
1. Minoxidil/Finasteride/Biotin (for men)
2. Minoxidil/Dutasteride/Biotin (for women over 45)
3. Minoxidil/Spironolactone/Biotin (for women under 45)
By signing this document, you confirm that you have been provided with all necessary information regarding the treatment, have had the opportunity to ask questions, and agree to proceed with full understanding of the potential risks and benefits.

Purpose of Treatment
The goal of this treatment is to promote hair regrowth and reduce hair loss. The prescribed compounded medications are customized to address individual patient needs and may offer improvement in hair density and quality over time. Results may vary, and no guarantees are made regarding the success of treatment.

Medications and Their Purpose
1. Minoxidil • Promotes hair regrowth by improving blood flow to the hair follicles.
2. Finasteride (men) or Dutasteride (women over 45) • Reduces the conversion of testosterone to dihydrotestosterone (DHT), which is implicated in androgenetic alopecia.
3. Spironolactone (women under 45) • A potassium-sparing diuretic that reduces the effects of androgens on hair follicles.
4. Biotin • A water-soluble vitamin believed to support healthy hair growth.

Potential Benefits • Increased hair regrowth and density. • Reduced hair shedding over time. • Improved hair texture and thickness.

Potential Risks and Side Effects
General Risks for All Formulations • Scalp irritation, redness, dryness, or itching (due to Minoxidil). • Temporary increase in hair shedding during the initial weeks of use. • Unintended hair growth on other areas of the body (due to Minoxidil). • No improvement in hair regrowth for some individuals.
Specific Risks by Medication
1. Minoxidil • Dizziness or lightheadedness. • Rapid heartbeat or chest pain (rare). • Fluid retention or swelling in the hands and feet.
2. Finasteride (Men) • Decreased libido or erectile dysfunction. • Breast tenderness or enlargement (gynecomastia). • Depression or mood changes. • Important: Can cause severe birth defects if handled by pregnant women.
3. Dutasteride (Women Over 45) • Breast tenderness or enlargement. • Menstrual irregularities (rare). • Risk of birth defects if handled during pregnancy. • May interfere with PSA levels in men.
4. Spironolactone (Women Under 45) • Risk of Hyperkalemia (elevated potassium levels): • Symptoms include muscle weakness, irregular heart rhythms, or fatigue. • Dizziness, lightheadedness, or low blood pressure. • Breast tenderness or menstrual irregularities. • Contraindicated in Pregnancy: May cause harm to the fetus.
5. Biotin • Generally well-tolerated, but high doses may interfere with lab test results, including thyroid and cardiac tests.

Treatment Expectations and Limitations
1. Results: Hair regrowth is a gradual process that may take several months of consistent use. Individual results vary, and some patients may not achieve the desired outcomes.
2. Compliance: Consistent use of the medication as prescribed is essential for effectiveness. Discontinuation of treatment may result in loss of regrown hair.
3. Off-Label Use: These compounded medications are not FDA-approved and are being used off-label to treat hair loss.

Contraindications
You confirm that you have disclosed any of the following conditions, which may contraindicate treatment: • Pregnancy, breastfeeding, or plans to conceive. • Known allergies to any components of the prescribed medications. • History of liver, kidney, or heart disease. • Any medical conditions that may increase risks associated with this treatment.

Liability Waiver
1. Acknowledgment of Risks: By signing this form, you acknowledge that you understand the potential risks and side effects associated with these medications and accept responsibility for any adverse effects that may occur.
2. Provider Responsibility: ZYP Medical, LLC and its prescribing providers are not liable for adverse outcomes if medications are used incorrectly or against medical advice.
3. Patient Responsibility: You agree to follow all prescribed instructions and notify your provider immediately if you experience side effects or unusual symptoms.
4. Pregnancy Warning: You acknowledge the severe risks to a fetus if these medications are used during pregnancy and accept full responsibility for preventing pregnancy during treatment.

Consent
By signing, You Agree (the patient), that you have read and fully understand this informed consent and liability waiver. I have had the opportunity to ask questions about the medications, their risks, and benefits. I voluntarily consent to proceed with the prescribed hair regrowth treatment and agree to the terms outlined above.