Avraham Schreiber, MD Concierge Services PC, The Remedy Realm,”  “we”, “us”, or “our”) own and operate the websites located at TheRemedyRealm.com This site is intended to facilitate the provision of the Services to registered users. The “Services” may include (i) providing individuals with information on health care and wellness (“Content”); (ii) providing individuals with access to technology-oriented tools for weight management; (iii) development and gathering of health care records and health care information with retention of the same for use in health care provider appointments, and communications; (iv) administrative support in connection with scheduling, and payment for health care provider services; and (v) telecommunications support for using the Services as a means of direct access to health care providers provided by The Remedy Realm, Avraham Schreiber, MD Concierge Services PC and similar affiliated professional entities for communication, consultations, assessments, and treatment by such health care organizations and their providers.

These terms and conditions of use (“Terms of Use”) describe your rights and responsibilities with regard to the The Remedy Realm  Sites that you may use to receive Services. Your access to and use of the Sites is subject to these Terms of Use, our Privacy Policy, as well all applicable laws and regulations. In these Terms of Use, the terms “you” and “yours” refer to the person using the Services. Even though you may have arrived to the Sites through a website or mobile application operated or controlled by a third party, you understand and agree that these Terms of Use are entered into between you and The Remedy Realm and Avraham Schreiber, MD Concierge Services PC. If you do not accept and agree to be bound by these Terms of Use, you are not authorized to access or otherwise use the Sites, Services or any information or Content provided through the Sites or Services. The Sites and Services are continually under development, and The Remedy Realm reserves the right to review or remove any part of these Terms of Use in its sole discretion at any time and without prior notice to you. Any changes to these Terms of Use are effective upon posting to the Sites. Unless otherwise indicated, any new content added to the service is also subject to these terms of use upon posting to the sites. If you disagree with these terms of use, your sole and exclusive Remedy is to discontinue your Use of the sites and/or services. Your continued use after a change has been posted constitutes your acceptance of the changes.

The medical services provided by The Remedy Realm and Avraham Schreiber MD Concierge Services PC are for the limited services of guidance in GLP-1 treatment. Those services are limited in scope to guidance in GLP-1 treatment only and nothing else. For any acute active or ongoing medical symptoms seek out immediate care with a medical facility in your proximity such as an emergency room and any immediately available urgent care or call 911 to attend to active issues. The Remedy Realm does not provide acute, urgent or emergency services. Once you have been stabilized, please make a routine appointment when you can discuss with your Remedy Realm provider to assess and determine if it should alter your treatment with The Remedy Realm. Our providers do not address medical emergencies. Do not proceed with clinical services using The Remedy Realm platform if you believe you are experiencing a medical emergency, you should dial 911 and/or go to the nearest emergency room without delay and without waiting for any response from The Remedy Realm or Avraham Schreiber, MD Concierge services PC.

To cancel your Remedy Realm subscription, you may call us or send an e-mail to support@theremedyrealm.com. Cancellation requests that come after a shipment has already been processed will be subject to a fee for that shipment, so if you are considering cancellation it is advised to do so within 2 weeks of your last delivery date to avoid any further charges.

Effect of The Remedy Realm Subscription Cancellation

Upon cancellation, you will not incur any further monthly subscription fee payments unless otherwise stated. Should you cancel once an order for shipment is already in process for your monthly membership you will still be charged for that monthly fee. The first shipment will provide a supply for 6 weeks. Regular shipments, occurring every 4-5 weeks, will commence once this initial 6-week period has ended. Once the initial 6-week startup period is complete, members can select different shipping frequencies, which will then align with their billing cycle. Shipments are generally made every 4-5 weeks (unless other options are chosen) and sometimes less or more due to holidays and business closures. We recommend consulting with your The Remedy Realm affiliated healthcare professional before discontinuing treatment as abruptly stopping certain medications may affect your health. If desired, you may initiate a new Diagnosis online visit to discuss rejoining the Remedy Realm program.

Except as otherwise stated, in any return or refund policy provided by the Remedy Realm, you acknowledge and agree that fees and charges for products and services purchased through the Remedy Realm are nonrefundable, either in whole or in part. You are fully liable for charges to your account, including any unauthorized charges. Patients who are screened by The Remedy Realm-Affiliated Healthcare professionals who have already paid and not yet shipped any medication who are found ineligible for treatment get a 100% refund. In regard to the medication, by signing below you are attesting to the following; you understand the possible side effects of the medications prescribed and understand that The Remedy Realm and Dr Schreiber and his representatives have made no guarantee concerning the results of use of the medications nor are they responsible for any such side effects and any side effects that may occur are occurrences that occur in some people and in some result in them being unable to tolerate the medication. You take full responsibility that if you do develop such symptoms you am entering into taking the medication knowing that it is a possibility and if they occur you agree that it is at your financial risk in that are not entitled to nor will you be able to get a refund in part or whole if they occur AND the consequences of such side effects are a part of chance in taking any medication as any medication could potentially cause side effects. You understand that side effects may be so severe or unpleasant that you may have to stop the medication. You understand and agree that in the case where side effects or other considerations cause you to have to stop the medication or any part of the regimen that none of your purchases made nor any sums paid towards consultations, or any other fees are refundable. There are no returns on any medications whether they have been opened or not nor refunds on any other purchases including but to the exclusion of needles, alcohol swabs, sharps containers or shipping fees. Once you consent to the prescription being sent you are responsible for payment and agree that none of any moneys or sums paid towards Dr Schreiber or The Remedy Realm are refundable in full or part at all. You also agree that should any offer be made to extend any courtesy in this regard it is no way binding and subject to The Conditions told to me in writing or verbally. Additionally, errors in drawing up incorrect amounts of medication or inadvertent wastage may cause you to run out earlier than expected. Should this occur and shipment of more medication or earlier shipment required it will be at a further expense to the customer.

The Remedy Realm offers a subscription based service through which eligible members can access limited medical care at the discretion of their provider, including physician services for a recurring monthly fee. Those physician services are of a limited nature as otherwise described in the terms herein. Please note; shipments will be made every 4-5 weeks. The first shipment will provide a supply for 6 weeks. Regular shipments, occurring every 4-5 weeks, will commence once this initial 6-week period has ended. Once the initial 6-week startup period is complete, members can select different shipping frequencies, which will then align with their billing cycle.

You will have the opportunity to review and agree to the monthly cost of the service (The “the remedy Realm subscription fee”) During the checkout process. Once you enroll in the Remedy Realm program, your subscription fee will be charged to your designated payment card each month until you cancel the service. This fee is nonrefundable. The first shipment upon initiation as a new patient will provide a supply for 6 weeks (if you are already on therapy you may choose form alternative options available and your billing and delivery will be determined by the option you choose (options available vary with dose but include every 4,5,6,8, 10 weeks) . Regular shipments, occurring every 4-5 weeks (or as per the option you have chosen), will commence once this initial 6-week period has ended. Once the initial 6-week startup period is complete, members can select different shipping frequencies, which will then align with their billing cycle. You may cancel your The Remedy Realm subscription by Contacting our support team via e-mail support@theremedyrealm.com or by texting us at (732) 669-5222.

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Human-based glucagon-like peptide-1 (GLP-1) receptor agonists (which include Semaglutide, Dulaglutide, Exenatide, Tirzepatide, etc.) are prescribed along with a reduced calorie diet and increased physical activity for weight management in adults with an initial body mass index (BMI) that is considered outside a healthy range. Common names for GLP-1 agonists include Adlyxin®, Byetta®, Bydureon®, Mounjaro®, Ozempic®, Rybelsus®, Trulicity®, Victoza®, Wegovy®. “Compounded” semaglutide, tirzepatide and retatrutide are also GLP-1 agonist medication.

You should not take GLP-1 agonist medications if: 

• You have a personal or family history of Medullary thyroid carcinoma, MTC, (a specific, rare type of thyroid cancer)

• Multiple Endocrine Neoplasia syndrome type 2 (MEN-2, a rare, genetic disorder that can cause tumors in the thyroid gland and other glands)

• Why? Because, in rodents, semaglutide (and potentially other GLP-1 medication) causes dose-dependent and treatment-duration-dependent thyroid C-Cell tumors at clinically relevant exposures. It is unknown whether semaglutide causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of semaglutide-induced rodent thyroid C-Cell tumors has not been determined.

• In light of the potential risk for MTC with use of GLP-1 medications (like semaglutide, tirzepatide or retatrutide), patients should be aware of symptoms of thyroid tumors (e.g. a mass in the neck, elevation of calcitonin, difficulty swallowing (dysphagia), difficulty breathing (dyspnea), persistent hoarseness, or other; and to seek appropriate evaluation for such signs or symptoms if present.

• You are pregnant or plan to become pregnant while taking this medicine. GLP-1 medications may cause fetal harm. When pregnancy is recognized, discontinue GLP-1 medications. Discontinue GLP-1 medications at least 2 months before a planned pregnancy. 

• You are a are diabetic and/or taking any medications related to lowering your blood sugar levels without speaking with your licensed, The Remedy Realm provider clinician.  GLP-1 medications lower blood glucose and can cause hypoglycemia, but even more so when combined with other blood sugar lowering medications. As a result, we need to know if you are prescribed Insulin (or other “hypoglycemic agent” medication (blood sugar lowering medication), because combining blood sugar lowering medication with GLP-1 medication may increase your risk of hypoglycemia (low blood sugar), and dosage adjustments by your provider to your medications may be necessary.   If you develop symptoms of hypoglycemia (light headedness, anxiety, shaking, sweating, rapid heartbeat, irritability or confusion, hunger, other), consume at least 15 grams of carbohydrate and, if possible, check blood glucose after 15 minutes to make sure it is over 70 mg / dL. If it is not, have another serving of carbohydrate. Once blood glucose is over 70 mg / dL, a meal should be consumed.

• You have a history of Pancreatitis or have a condition that may make Pancreatitis more likely to occur. Acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with GLP-1 receptor agonists (like semaglutide, tirzepatide and retatrutide). Symptoms of acute pancreatitis could include severe abdominal pain, sometimes radiating to the back, and which may or may not be accompanied by vomiting. If acute pancreatitis is suspected, discontinue any GLP-1 medication (i.e. semaglutide, tirzepatide or retatrutide) medication promptly and seek urgent medical attention for a proper pancreatitis evaluation including exam, blood tests, and potentially imaging studies. If acute pancreatitis is confirmed, do not restart GLP-1 medication.

• You have a history of gallbladder disease. While not an an absolute “contra-indication” to GLP-1 medications, treatment with GLP-1 medications (i.e. semaglutide, tirzepatide or retatrutide) was associated with an increased occurrence of cholelithiasis (gallstones) and cholecystitis (gallbladder inflammation). For example, in clinical trials in adult patients, cholelithiasis was reported by 1.6% of Wegovy® (semaglutide) patients and 0.7% of placebo patients. The incidence of cholelithiasis (gallstones) and cholecystitis (gallbladder inflammation) was higher in Wegovy® (semaglutide) treated pediatric patients (aged 12 years and older) than in Wegovy® (semaglutide) treated adults. Cholecystitis was reported by 0.6% of Wegovy® (semaglutide) patients and 0.2% of placebo patients. Substantial or rapid weight loss can increase the risk of cholelithiasis (gallstones); however, the incidence of acute gallbladder disease greater in Wegovy® (semaglutide) patients than in placebo patients, even after accounting for the degree of weight loss. If cholelithiasis (gallstone disease) is suspected, gallbladder studies and appropriate clinical follow-up are indicated.

• You have kidney disease or are on dialysis. There have been post-marketing reports of acute kidney injury and worsening of chronic kidney failure, which in some cases required hemodialysis, in patients treated with semaglutide. Patients with renal (kidney) impairment may be at a greater risk of acute kidney injury, but some events have been reported in patients without underlying kidney (renal) disease. A majority of the events occurred in patients who experienced nausea, vomiting, or diarrhea, leading to volume (fluid) depletion. Renal (kidney) function will be monitored prior to starting a GLP-1 medication and along your weight loss journey as needed and more frequently if reporting any adverse reactions that could lead to volume depletion.

• You are allergic to any GLP-1 agonist such as: Adlyxin®, Byetta®, Bydureon®, Mounjaro®, Ozempic®, Rybelsus®, Trulicity®, Victoza®, Wegovy®, or “compounded” semaglutide,  tirzepatide or retatrutide.

• You are taking any other GLP-1 agonist medication.

• You have other concerning allergies. Serious hypersensitivity (allergic) reactions (e.g. anaphylaxis, angiodedema) have been reported with GLP-1 medication. These medications may contain inactive ingredients, which can cause allergic reactions or other problems. If hypersensitivity (allergic) reactions occur, discontinue use of GLP-1 medication and seek treatment promptly as well as monitoring until symptoms resolve.

• You have a history of diabetic retinopathy or diabetes: In a trial of adult patients with type 2 diabetes, diabetic retinopathy was reported by 4% of Wegovy® (semaglutide) patients and 2.7% of placebo patients. Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy. Patients with a history of diabetic retinopathy on GLP-1 medications should be monitored for progression of diabetic retinopathy by their ophthalmologist.

• Pediatric populations: Although pediatric adverse reactions were not thoroughly studied in every GLP-1 medication, adverse reactions with semaglutide (a GLP-1 medication) in pediatric patients aged 12 years and older were similar to those reported in adults. Pediatric patients 12 years and older treated with semaglutide (Wegovy®) had greater incidences of cholelithiasis (gallstones), cholecystitis (inflammation of the gallbladder), hypotension, rash, and urticaria (hives from an allergic reaction to medication) compared to adults treated with semaglutide (Wegovy®).

Before using this medication, you agree that you will provide your complete medical history and a list of medications you are currently taking to your licensed, The Remedy Realm provider clinician. Specifically, please inform your The Remedy Realm clinician about any medications (including prescription drugs, over-the-counter medications, vitamins, and supplements) you are currently taking that may lower your blood sugar. Possible drug interactions with GLP-1 agonists include insulin and sulfonylureas due to the increased risk of hypoglycemia (low blood sugar).

The following mild side effects may occur as a result of taking a GLP-1 agonist: nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, dyspepsia, dizziness, abdominal distension, belching, burping, hypoglycemia, flatulence, gastroenteritis, and gastroesophageal reflux disease, nasopharyngitis (runny nose), and / or common injection site reactions characterized by itching, burning at site of administration with or without thickening of the skin(welting).

 In rare cases, the following serious side effects have occurred when using a GLP-1 agonist: 

• Serious allergic reaction, including rash, itching/swelling (especially of the face/tongue/throat)

• Swelling of the feet, ankles, or lower legs

• Severe dizziness

• Trouble breathing

• Pancreatitis

• Heart problems, including palpitations

• Symptoms of de-hydration, including extreme thirst, very dry mouth or skin, decreased urination, dizzy with standing, etc.

Drug Interactions

GLP-1 medication causes a delay of gastric emptying that has the potential to impact the absorption of concomitantly administered oral medications. Monitor the effects of oral medications concomitantly administered with GLP-1 medications and report any concerning or adverse side effects from other medications to your The Remedy Realm provider clinician. GLP-1 medications interact with drugs in the class of monoamine oxide inhibitors and should not be taken if you are on any MOA inhibitors. Examples of MOA inhibitors include; isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate). Advise your clinician if you are taking any of these.

PLEASE NOTE THAT THIS IS NOT A COMPLETE LIST OF ALL POSSIBLE SIDE EFFECTS. OTHER SIDE EFFECTS MAY OCCUR. Report all adverse side effects to your The Remedy Realm clinician. In the event of any emergency, call 911 or go to the nearest emergency room immediately.  

IF YOU HAVE ANY QUESTIONS AS TO THE RISKS OR HAZARDS OF THIS TREATMENT, OR ANY QUESTIONS WHATSOEVER CONCERNING THIS PROPOSED TREATMENT OR OTHER POSSIBLE TREATMENTS, ASK YOUR THE REMEDY REALM CLINICIAN BEFORE SIGNING THIS CONSENT FORM. 

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