Ordering your PDA (Pentadeca Arginate) is fast, private, and hassle-free.

Please check all boxes that apply to each question:

To complete your identity verification, please upload a clear photo of your government-issued ID along with a selfie of yourself holding the ID. This helps us ensure a smooth and secure verification process.

Telemedicine services through Wittmer Rejuvenation Clinic are provided by medical providers contracted directly with (WRC). Our medical providers are licensed in all 50 states, and DC. By signing this form, you hereby consent to communicate with the Providers through telemedicine and receive diagnostic and treatment services via telemedicine. You further acknowledge the following:

• I understand that telemedicine is the use of electronic information and communication technologies by a healthcare provider to deliver services to an individual when they are located at a different site than the provider; and hereby consent to the Providers providing healthcare services to me via telemedicine.

• I understand that the same standard of care applies to a telemedicine visit as applies to an in-person visit.

• I acknowledge and understand that this telehealth consultation is for elective treatments and is not intended to diagnose, treat, or manage any medical illness or emergency condition. I confirm that I am not currently experiencing any symptoms of a serious medical condition that would require immediate or in-person medical attention.

• I understand that health care delivery via telehealth is not analogous to an in-person delivery and assessment and that distorted photos, videos, or audio could lead to an incorrect diagnosis or conclusion and that there are potential risks to using telehealth, including interruptions, unauthorized access, and technical difficulties. If it is determined that the method of communication, videoconferencing equipment and/or connection is not adequate, I understand that my healthcare provider or I may discontinue the telemedicine visit and make other arrangements to continue the visit.

• As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks include, but may not be limited to:

• In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the physician and consultant(s); Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information

• In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reaction or other judgment error

• I understand that the laws that protect privacy and the confidentiality of medical

• information also applies to telemedicine, and that no information obtained in the use of telemedicine which identifies me will be disclosed to researchers or other entities without my consent. 

• I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time. I may revoke my consent orally or in writing at any time by contacting [email protected]

• I understand that a variety of alternative methods of medical care may be available to me and that I may choose one or more of these at any time.

• I understand that telemedicine may involve electronic communication of my personal medical information to other medical practitioners who may be located in other areas, including out of state.

• I understand that it is my duty to inform the Physician of electronic interactions regarding my care that I may have with other healthcare providers.

• I understand that I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured.

• By placing your order, I am certifying that I have read or had this form explained to me, have had my questions answered to my satisfaction, and fully understand its contents. I have been offered a copy of this consent form. This document will become part of my medical record.

1. Overview of Peptide Therapy

Peptides are short chains of amino acids that act as signaling molecules in the body, regulating various physiological functions such as hormone production, metabolism, tissue repair, immune function, and neurological health.

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Common peptides include:

🔹 Growth Hormone Releasing Peptides

🔹 Metabolic & Weight Loss Peptides

🔹 Sexual Health Peptides

🔹 Tissue Repair & Recovery Peptides

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Peptide therapy is customized based on individual needs and administered via injection, oral, or topical routes.

3. Potential Risks & Side Effects

I acknowledge that I have been informed of possible side effects, which may include:

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Common Side Effects:

🔸 Injection Site Reactions (redness, swelling, irritation)

🔸 Mild Nausea, Dizziness, or Fatigue

🔸 Temporary Water Retention or Swelling

🔸 Changes in Appetite or Digestive Issues

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Serious Risks (Rare but Possible):

⚠️ Hormonal Imbalances (e.g., increased cortisol, testosterone, or estrogen levels)

⚠️ Hypoglycemia (Low Blood Sugar) (especially with metabolic peptides)

⚠️ Allergic Reactions (rash, itching, difficulty breathing)

⚠️ Heart Palpitations or Increased Blood Pressure

⚠️ Unwanted Changes in Growth Factor Levels

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🚨 DO NOT TAKE if you have:

Active Cancer or a History of Cancer (certain peptides may stimulate growth factors)

Severe Heart, Kidney, or Liver Disease

Uncontrolled Diabetes or Thyroid Disorders (unless approved by a provider)

Pregnancy or Breastfeeding (unless cleared by a provider)

5. Alternative Treatment Options

I acknowledge that alternatives may include:

Lifestyle & dietary modifications

Hormone replacement therapy (HRT)

Other prescription or over-the-counter treatments