Informed consent

Compounded prescription peptides

Southend Pharmacy · patient-specific prescription · shipped to you

SoTul Aesthetics LLC · (918) 260-8064 · sotulaesthetics@gmail.com

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Patient

  • Patient name
  • Date of birth
  • Date of visit
  • Phone
  • Ship-to address (Oklahoma)

What I am agreeing to

I am requesting a medical evaluation by Shaun Baranowski, APRN-CNM, WHNP-BC (SoTul Aesthetics LLC) for a compounded peptide protocol. A prescription is written only after that visit, and only if it is a fit.

If a prescription is written, it goes to Southend Pharmacy, a licensed 503A compounding pharmacy. Southend compounds the medication for me and ships it to my Oklahoma address. Southend bills the vial and shipping. SoTul bills the visit. SoTul does not stock these vials for office use.

These peptides are compounded. They are not FDA-approved finished drugs. They are not research chemicals and will not be ordered from a “not for human use” vendor. Quality, strength, and purity are the responsibility of the compounding pharmacy. Results vary. No outcome is guaranteed.

Protocols that may be discussed

  • BPC-157
  • Wolverine (BPC-157 + TB-500)
  • Sermorelin
  • CJC-1295 / Ipamorelin
  • PT-141
  • NAD+ injectable
  • GHK-Cu injectable
  • Another Southend compound, if Shaun determines it is a better fit

Weight-loss medicine, when appropriate, is prescribed as the brand product. Compounded semaglutide and tirzepatide are not offered on the menu.

Injections

Subcutaneous injections are taught in person or on video before I inject at home. I will use only the dose and schedule on my instructions. I will not share vials. I will store the shipment as labeled, including cold-chain instructions.

Common effects include bruising, redness, soreness, or a small bleed at the injection site. Infection is uncommon and more likely if supplies are reused or skin is not cleaned. I will stop and contact Shaun if I develop a spreading rash, swelling, fever, or trouble breathing. For a severe or breathing reaction I will call 911.

Pregnancy and nursing

I will not use a compounded peptide if I am pregnant or breastfeeding unless Shaun clears a specific plan in writing. I will tell Shaun immediately if I become pregnant during therapy.

Money, photos, and privacy

Visit fees are paid to SoTul Aesthetics LLC. The vial and shipping are billed by Southend. Prices on the menu are typical ranges as of September 2026, not a guaranteed pharmacy quote. Labs, if ordered, are billed separately. Follow-up is required before the first refill.

This is cash-pay and is not billed to medical insurance. I may keep receipts for HSA/FSA submission at my own discretion.

I consent to clinical photos for my chart. Separate written permission is required before any photo is used for education or social media.

Telehealth visits, texts, and emails are convenient and are not fully private. I will not send emergency messages by text.

Alternatives

I may decline a compounded peptide. Alternatives include doing nothing, physical therapy or other local care, FDA-approved medicines from a retail pharmacy when one exists for my concern, or a referral.

My questions were answered

I have had a chance to ask questions. I understand the plan, the risks, and that I may refuse or stop at any time. I am not signing under pressure. I am signing for myself, or I am the legal representative of the patient named above.

Patient / legal representative signature

Date

Printed name

Relationship, if not the patient

Prescriber

Shaun Baranowski, APRN-CNM, WHNP-BC · SoTul Aesthetics LLC
Independent prescriptive authority, Oklahoma · Medical oversight: Dr. Carlos Guevara

Prescriber signature

Date