3 Terms, Conditions & Consent for IV Therapy
Our IV therapy is specifically designed to counteract symptoms of dehydration, fatigue, the residual effects of alcohol ingestion, and to promote health and wellness. We offer no diagnostic testing, make no medical diagnoses, and reserve the right to refuse treatment to any patients we deem are acutely intoxicated, unstable, or whose symptoms are not consistent with the above medical history. The vast majority of our clients receiving our therapy feel greatly improved; however, every individual is different and there is no guarantee that you will feel different after our IV therapy ; nor does your improvement of symptoms exclude other coexisting potential medical conditions. This document is designed to serve as confirmation of informed consent for IV therapy as suggested by the qualified provider at Refresh.
I have informed Refresh of any known allergies to drugs or other substances, or of any past reactions to IV therapy. I have given a list of all current medications and supplements I'm taking. I understand that I have the right to be informed of the service, any feasible alternative options, and the risks and benefits. Services are not performed until I have had an opportunity to receive such information and give my concerns. I understand that:
- The procedure involves inserting a needle into a vein and injecting the selected solution, vitamins, and/or medications.
- Risks of intravenous therapy include, but are not limited to: Discomfort, bruising, and pain at the site of injection.
- Risks of intravenous therapy include, but are not limited to: Discomfort, bruising, and pain at the site of injection.
- Rarely: Inflammation of the vein used for injection, phlebitis, metabolic disturbances, injury, and allergic reaction.
- Rarely: Inflammation of the vein used for injection, phlebitis, metabolic disturbances, injury, and allergic reaction.
- Nutrients are forced into the cells by means of a high concentration ingredient.
- I understand the information provided on this form and agree to the foregoing.
- I have received all the information and explanation I desire concerning the procedure/ IV therapy.
