1. Benefits of intravenous therapy:
· IV therapy is not affected by stomach or intestinal disease/malabsorption.
· Full amount of IV infusion enters the bloodstream for availability to tissues.
· Higher doses of nutrients can be given intravenously without intestinal irritation that can accompany doses given orally.
2) Risks and potential side effects of intravenous therapy:
· Discomfort, bruising, and pain at the site of injection.
· Inflammation of the vein used for injection, phlebitis, metabolic disturbances, and injury.
· Severe reaction, anaphylaxis, cardiac arrest, or death.
3. Alternatives to IV vitamin therapy:
· Oral supplementation
· Dietary and lifestyle changes
I understand that I have the right to consent to or refuse any treatment at any time prior to its administration. My signature on this form affirms that I have given my consent to intravenous therapy and I am aware that other unforeseen complications can occur. Therefore, I give my consent to Drip MB Hydration & Wellness using the Emergency Protocol should it be deemed necessary by the Medical Provider. If the Emergency Protocol is not effective for the client, Drip MB Hydration & Wellness medical provider reserve the right to call 911.
I understand that if I am currently, or was recently, under the influence of drugs and/or alcohol that Drip MB Hydration & Wellness is not responsible for any adverse effects or interactions as a result of receiving IV Vitamin Therapy.
I understand the risks and benefits of the procedure and have had the opportunity to have all my questions answered by Drip MB Hydration & Wellness medical staff.
I understand that there is no implied or stated guarantee of success or effectiveness of any treatment offered at Drip MB Hydration & Wellness. I understand that Drip MB Hydration & Wellness is not treating or diagnosing any condition. I understand that I am free to withdraw my consent and to discontinue participation in treatment at any time. I understand that I will incur the full fee for treatment regardless of amount used.
I understand that I am consenting to an automatic blood draw and blood testing in the event of any accidental bloodborne or bodily fluid exposure to any Drip MB Hydration & Wellness staff member.
I understand that all the nutrient infusions given at Drip MB Hydration and Wellness are considered investigational/experimental. These infusions are not considered standard of care and are not billable to insurance.