IV Therapy Payment Form - Magnolia Wellness Center

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Parent/Guardian Name (If under 18)

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Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

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Parent/ Guardian Email Address

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Address

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Signature - By signing this document, you understand there is no refund on services you have purchased. Please bring Photo ID to the appointments. If you are under 18, you must have a parent present to sign consent forms.

My Products

IV THERAPY - CONTESTANT

We have 3 different options: Get up and Go for energy, Immunity Booster for your immune system, and just a bag of fluids!

$150.00

IV THERAPY - Family/Friend

$175.00 Quantity

LED Therapy

LED Therapy is an non invasive treatment that helps improve the skins overall glow. It will help reduce inflammation, acne, redness, while helping the collagen in the skin. This is the perfect 30 minute session to get your skin in shape and to relax with music of your choice!

$35.00

B12 Injection

Before purchasing, please make sure this is not already in an IV Therapy bag if you are doing IV Therapy.

$30.00

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