H&P CERTIFICATION — GLUTATHIONE INJECTIONS

KosherMedications.com
Health & Physical (H&P) Self-Assessment Declaration

By completing my purchase of Glutathione Injections through KosherMedications.com, I certify under penalty of perjury that the following statements are true and correct to the best of my knowledge and belief. I understand that a licensed healthcare provider will rely upon this information when determining whether a prescription or compounded preparation is clinically appropriate.

General Information

I affirm that I:

• am 18 years or older, completing this assessment for myself, voluntarily, and providing accurate identifying information including my full name, address, and contact details.

• will use this service and any prescribed medication solely for myself and will not share or distribute it to others.

• understand that Glutathione Injections may be dispensed only if medically appropriate, based on my self-reported information and provider review.

• acknowledge that a licensed healthcare provider may contact me for clarification or additional details before approval.

• have reviewed and accepted KosherMedications.com’s Terms of Service and Consent to Telehealth, which govern this interaction and any provided care.

Consent to Telehealth

I understand and acknowledge that:

• This service uses an asynchronous telehealth model, allowing me to provide medical information online for review by a licensed provider.

• A valid provider-patient relationship is created for this encounter and may include follow-up communication if needed.

• Telehealth is a supplemental mode of care and does not replace in-person evaluation or ongoing monitoring by my primary provider.

• Because of the nature of telemedicine, the reviewing provider cannot continuously monitor my condition, lab results, or side effects. I accept these limitations and risks.

• All personal and medical information will be transmitted and stored securely, in compliance with HIPAA and applicable privacy laws.

• In the event of a medical emergency, I will call 911 or seek immediate in-person emergency care and will not rely on telehealth communication for urgent or life-threatening issues.

Clinical Information Related to Glutathione Injections

I confirm that I:

• understand that Glutathione is a naturally occurring antioxidant involved in detoxification, immune support, and cellular defense, but is not FDA-approved for any specific medical indication.

• understand that Glutathione Injections may be used as supplemental antioxidant therapy and may support detoxification pathways, liver function, and wellness routines.

• have not experienced hypersensitivity or allergic reactions to Glutathione, sulfur-containing compounds, or any components in the formulation.

• do not have the following medical conditions that may increase risk:

  • uncontrolled asthma or a history of bronchospasm

  • severe liver or kidney impairment

  • active infection or systemic inflammation

  • recent major surgery or immune compromise

• understand that rare cases of worsening asthma or bronchoconstriction have been reported with inhaled or parenteral Glutathione and that I should stop use and seek care if I experience breathing difficulty.

• understand potential side effects, including:

  • nausea

  • abdominal cramping

  • injection site irritation

  • dizziness

  • headache

  • flushing

• understand that Glutathione is sometimes marketed for skin-lightening, and that such use carries safety concerns and is not an FDA-approved indication.

• will discontinue use and seek medical care if I experience:

  • difficulty breathing

  • chest tightness

  • widespread rash or swelling

  • signs of liver or kidney distress

• am not pregnant or breastfeeding, and will notify the provider if this changes.

• will inform the reviewing provider of all current medications, supplements, antioxidants, and herbal products, as Glutathione may influence hepatic detox pathways or interact with medications requiring glutathione-dependent metabolism.

• understand that Glutathione Injections are commonly compounded, and compounded medications are not FDA-approved but are prepared in licensed facilities according to U.S. compounding standards.

Health Status & Representations

I attest that I:

• am in generally good health, apart from the purposes for which I am seeking Glutathione support.

• have truthfully disclosed all relevant medical history, medications, allergies, and respiratory conditions.

• understand that my submission may be reviewed by a licensed provider, who may request further information before issuing a prescription.

• confirm that this certification reflects all relevant information I would disclose during an in-person clinical visit.

General Information About Prescription or Compounded Medications

I understand that:

• This certification does not list all risks, interactions, or side effects associated with Glutathione Injections.

• Glutathione may be compounded, and compounded medications are not reviewed or approved by the FDA.

• Additional information about medications and interactions is available at:

  • www.fda.gov

  • www.drugs.com/drug_interactions.html

• I will review any compounding instructions or medication guides supplied with my prescription and consult my provider if I have additional questions.

Pharmacy & Fulfillment Information

I acknowledge that:

• KosherMedications.com partners with licensed pharmacies and compounding facilities to dispense medications in accordance with state and federal law.

• Reviewing providers act independently and are not employees of the pharmacy.

• I consent to receive education materials, renewal reminders, and updates electronically.

• I am responsible for reviewing this certification and contacting support@koshermedications.com with any concerns before beginning treatment.

Emergency Disclaimer

I understand that KosherMedications.com and its affiliated providers do not provide emergency medical services.
In the event of an emergency or severe reaction, I will call 911 or seek immediate in-person care at the nearest emergency department.

By completing my purchase, I affirm that all statements above are true, accurate, and complete to the best of my knowledge.