Champion Health and Wellness Clinics

4295 San Felipe St., Ste. 235 Houston TX 77027

281-501-0611

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Patient Information

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Consent Forms

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Initial Consultation

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Completed

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Full Name *

Email : *

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Please read the Consent Forms below :

Eligibility for Semaglutide / Tirzepatide
Consent for Semaglutide/Tirzepatide
Privacy Policy
Consent to Participate in Telemedicine Consultation
Weight Management
Consent for Medically Management Weight Loss Therapy
New Tirzepatide Formula
B6 B12 and Glycine Injections Informed Consent

Please read and confirm: *

I hereby confirm that I have read and fully understand the contents of the consent forms provided to me. I acknowledge that I have had the opportunity to ask any questions regarding the information contained within these forms and that all my questions have been answered to my satisfaction. By signing below, I agree to the terms and conditions outlined in the consent forms.

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