REVO WELLNESS PEPTIDE INTAKE FORM

This Peptide Intake Consultation is designed to capture a clear snapshot of your current health and fitness, identify your specific goals, and build excitement around what’s possible when you follow a personalized, strategic plan. We’ll review your lifestyle, training, recovery, stress, and wellness history to understand where you are today and where you want to go. You’ll walk away with a clear blueprint outlining the next steps to support your goals—whether that’s improved energy, fat loss, performance, recovery, or longevity.

As a trusted referral of one of our REVO partners, you’ll receive this consultation for $99 (a $299 value) and $50 will be credited to your order. Following your intake, you’ll be seamlessly redirected to schedule a follow-up call with one of our health experts to finalize recommendations and begin your optimization journey.

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PEPTIDE THERAPY CONSENT FORM


This consent form confirms that the patient understands the nature, risks, benefits, and regulatory status of peptide therapies used at REVO Wellness, and voluntarily elects to proceed with treatment. 

1. Peptide Sources and Quality 

REVO Wellness utilizes peptide medications that are either: 

• 503 compounded peptides sourced exclusively from licensed, regulated pharmacies, or 

• Physician-Use-Only peptides 

These sources represent the highest quality peptides available in the United States. They are not available to the general public and can only be obtained through a licensed medical provider. 

2. FDA Status of Peptide Therapies 

The patient understands and acknowledges the following: 

• Many peptide therapies have not been evaluated or approved by the U.S. Food and Drug Administration (FDA). • Despite lack of FDA evaluation, peptides used in clinical wellness settings have historically shown strong safety profiles and may offer significant therapeutic benefit depending on individual response. 

• Use of peptides in this context may be considered off-label or experimental. 

3. Alternative Medicine Acknowledgment 

The patient understands that: 

• Peptide therapy is considered an alternative or complementary medical approach, separate from traditional allopathic (conventional) medicine. 

• Treatment decisions involving peptides may not align with standard medical guidelines followed in primary care or hospital based medicine. 

• The patient is choosing to pursue peptide therapy as part of a personalized wellness plan provided by REVO Wellness.

4. Patient Consent 

By signing this form, the patient confirms that they: 

1. Understand the nature and purpose of peptide therapy. 

2. Understand the regulatory status and FDA limitations regarding peptide medications. 

3. Acknowledge that treatment through 503 or Physician-Use-Only sources represents the highest available quality but may not be FDA-evaluated. 

4. Voluntarily consent to the use of peptide therapy as part of their care plan at REVO Wellness. 

5. Have had the opportunity to ask questions and receive clear answers. 

6. Accept responsibility for informing the provider of any medical changes, adverse reactions, or concerns.

REVO RETURN POLICY 

RETURN & REFUND POLICY 
At Revo Wellness, we value transparency and clarity. Please read carefully before making a purchase. 

REFUND ELIGIBILITY 
We only offer refunds under these two circumstances: 

1. Product Recall – If a medication or product is recalled by the manufacturer, pharmacy, or government agency. 2. Shipping Damage by Carrier – If your order arrives damaged due to UPS or other shipping carriers. 

NO OTHER REFUNDS WILL BE ISSUED for any reason, including: 
• Change of mind, dissatisfaction with results, or discontinuing treatment. 
• Outstanding balances on 3-month or 6-month packages.
These packages are offered at a discounted rate for client retention; partial refunds will not be provided once purchased. 

REPLACEMENTS 
If your item qualifies for a refund reason above, we may offer a replacement instead of a refund at our discretion.

REPORTING A CLAIM 
• Contact our office within 7 days of receiving your order at 727-506-8297. 
• Provide photos and details of the damage or recall notice. 
• Ship returns to: 

Revo Wellness
327 11th Ave N, Suite 203 
St. Petersburg, FL 33701 

FINAL NOTE 
There is 6% sales tax and a 2.6% card processing fee applied to every order. If you'd like to avoid the card processing fee, we aslo accept cash or Zelle. By purchasing from Revo Wellness, you agree to this policy. This policy overrides any prior agreements. 

CHARGEBACKS INITIATED BY THE PATIENT 
Revo Wellness takes patient care very seriously, and our clinic strives to provide the highest quality care to every individual. In the event the patient is not satisfied, we ask he please refer to this document rather than initiating a chargeback with his or her credit card company. If a chargeback is initiated, Revo Wellness will use all documentation available to refute the chargeback including patient acknowledgment of the refund policy.

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Once submitted, you will be redirected to the REVO Wellness booking platform to schedule your consultation with Bryce Gonzalez.