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Hormone Replacement Therapy Protocol Agreement

Health and wellness, along with medical stability of our patients, is the priority of Viking Alternative Medicine

  1. Protocols and recommended treatment will be based on the discretion of the practitioner during consultations.
  2. Initial labs are required, will need to be repeated between 5 to 7 weeks, and maintained every 6 months afterwards. However, the practitioner might require additional or more frequent testing based on individual patient needs and/or medical conditions.
  3. If at any time the practitioner feels a peptide or medication is no longer beneficial or is detrimental to your health it will be discussed during your consultation and removed from your protocol.
  4. If a patient does not have the required labs completed within the allotted time frame, he/she will not be able to refill their protocol until they are completed and reviewed by the practitioner.
  5. If a patient’s hormone levels do not fall below the standard for hormone optimization, off-label HRT protocols then additional lab tests will be required to determine if a patient is a candidate for HRT with Viking. This will be required prior to the initial consultation.
  6. If a patient does not have therapeutic phlebotomies performed at least 3-4 times a year or labs are deemed unstable, HRT will be adjusted or held until stability and/or proper treatment is obtained.
  7. If a patient deviates or does not follow recommended protocol and puts his/her health at risk, they will be considered a non-compliant patient and VIKING will reserve the right to terminate services.
  8. I have read, understand, and agree to the above requirements.

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