Home Delivery IV Kit Sign-Up

Name

First Name Last Name

Address

Street Address

Street Address Line 2

City

Postal / Zip Code Country

Phone Number

Area Code Phone Number

Email

example@example.com

How many kits would you like? (maximum 4 per person)

When is your preferred time for delivery?

Tuesday, Mar 12 Morning Tuesday, May 12 Afternoon Wednesday, May 13 Morning Wednesday, May 13 Afternoon

Is anyone who will be receiving this IV 1) over the age of 65, or suffer with 2) Heart Disease or 3) Kidney Disease?

Yes No

If yes to above, please explain (or include any comments as needed):

By submitting below, you are agreeing with the following:

I am purchasing a take-home IV kit for personal use. I agree not to resell this to others. I agree to use this IV Kit only for its intended use. I understand Nuvo You is providing vitamins which are a nutritional supplement and not drugs. I understand these are not intended to treat or prevent any disease or disease process, and Nuvo You makes no claims or representations as such. I agree to hold Nuvo You and Dr. Sabbani harmless from any injury or damage that may occur with use of this product, and release Nuvo You and Dr. Sabbani from any liability whatsoever.

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