• I am between the ages of 18 and 68.
• I am currently on thyroid medication for treatment of hypothyroid condition.
• I am not on Coumadin/Wafarin.
• I am not allergic to Armour thyroid or equivalent.
• I understand that all medication changes include the risk of fatal allergic reaction, unintended side effects and therapeutic failure.
• I understand that risks specific to thyroid medication include worsening goiter, heart rhythm problems and palpitations and possible osteoporosis from long term overcorrection.
• I understand that overcorrection with T3 containing medications may result in heart palpitations, increased insomnia, and anxiety.
• I agree to stop medication and seek immediate medical care should any problems arise from my taking T3 containing medication.
• I realize that I am undertaking empiric triall of T3 medication on an experimental basis for the treatment of symptoms associated with previously diagnosed under active thyroid.
• I agree to obtain follow up labs per direction of Dr. Bouc.
• I agree to email communication regarding lab results and medication changes.

Dr. Bouc will not be responsible to respond to day to day questions regarding your thyroid or response to medication. If you are having problems with the change, then you are best served by seeing your primary medical doctor. This site is only to provide you with a prescription of T3 containing medication, in substitution for Levothyroxine, and is not intended to diagnose or treat your entire health status.