Informed Consent for Off-Label Use

I understand while the allergens that may be added to the Easily™ toothpaste base are approved by the Food and Drug Administration (FDA) for the immune cells under the skin, the addition of the allergens to the Easily™ toothpaste base is an off-label (non-FDA approved) use of this medication. I understand that off-label use is the physician practice of prescribing a drug for a purpose different from one of the indications for which the product is approved by the FDA. I also acknowledge that I will review the use of this medication with my provider in detail.

If appropriate, I request that the provider proceed with the off-label prescription of Easily™.