Prime HRT & Weight Loss
Please select your options below, fill out medical history and sign consent form
Select your preferred treatment
prev
next
( X )
IV Hydration- Normal Saline 1L (1000ml)
Rehydrate and recover faster with 1 liter of 0.9% Normal Saline, restoring fluid balance and replenishing electrolytes after intense activity. It prevents dehydration, reduces fatigue, and supports muscle recovery by flushing out toxins. Ideal for athletes needing rapid hydration and enhanced recovery before, during, or after competition.
$
85.00
Quantity
1
2
3
IV Hydration- Normal Saline 500ml
$
45.00
Quantity
1
2
3
Myers Cocktail IV Hydration
Boost your performance and recovery with our Myers' Cocktail IV, designed to enhance energy, muscle function, and overall health. Key ingredients like Magnesium, B-Vitamins, Hydroxo B12, Calcium, and Vitamin C promote faster recovery, improve focus, and support immune health. Perfect for pre- or post-workout, it helps you stay at your peak performance.
$
145.00
Quantity
1
2
3
4
5
6
7
8
9
10
Toradol (Ketoralac) 30mg
Toradol (Ketorolac) is a powerful NSAID that quickly relieves pain and reduces inflammation, allowing athletes to perform without distractions. It alleviates muscle soreness, joint pain, and minor injuries, promoting faster recovery and better mobility without causing drowsiness. Ideal for pre-competition use, Toradol helps athletes manage pain and stay focused, reducing downtime and maintaining peak performance.
$
30.00
Quantity
1
2
Methylcobalamin (B-12) 5mg Injection or add to IV
B12 injections enhance energy, endurance, and recovery by supporting red blood cell production and improving oxygen transport, reducing fatigue during intense activity. They increase stamina, allowing for longer, harder training sessions, while also boosting focus and mental clarity. B12 injections speed muscle repair and strengthen the immune system, helping athletes stay healthy and perform at their best. Ideal for those looking to optimize energy and recovery, B12 injections are a game-changer for performance.
$
15.00
Quantity
1
2
Glutathione 200mg Injection or add to IV
Glutathione injections are a powerful antioxidant that helps athletes reduce oxidative stress, protect cells, and enhance recovery. It aids in detoxification, speeds up muscle recovery, and boosts immune function for better overall health. Additionally, it promotes healthier skin by reducing oxidative damage. Perfect for athletes looking to reduce recovery time, prevent cell damage, and maintain peak performance before or after competition.
$
20.00
Quantity
1
2
L-Carnitine 500mg Injection or add to IV
L-Carnitine injections help athletes boost energy by transporting fatty acids into cells for fuel, enhancing endurance and delaying fatigue during intense exercise. It supports fat metabolism, turning stored fat into usable energy while maintaining muscle mass. L-Carnitine also aids in muscle recovery by reducing soreness and improving nutrient delivery to muscles. Ideal for pre- or post-workout, it helps athletes increase energy, burn fat, and recover faster for improved performance.
$
30.00
Quantity
1
2
Date you will be getting your IV or Injection
-
Month
-
Day
Year
Date
Back
Next
Name
*
First Name
Last Name
Birthdate
*
Month Day Year
Sex
Male
Female
Email
*
example@example.com
Emergency Contact
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Back
Next
Medical History
Are you pregnant?
Yes
No
Have you ever been told that you have an electrolyte imbalance or other abnormal labs?
Yes
No
Do you have any of the following conditions?
Select yes or no
Blood pressure problems (high or low)
Yes
No
Heart Problems
Yes
No
Stroke or “mini stroke"
Yes
No
Kidney problems
Yes
No
Kidney Stones
Yes
No
Asthma
Yes
No
Optic nerve atrophy or Leber's Disease
Yes
No
Sickle Cell Anemia
Yes
No
G6PD Deficiency
Yes
No
Sarcoidosis
Yes
No
Parathyroid problems (high levels)
Yes
No
Are you a diabetic?
Yes
No
Are you a smoker?
Yes
No
Back
Next
Drug Allergies
*
Over the counter medications including vitamins and other supplements:
List any other medical condition you have (not mentioned on previous page):
Prescription medications, strength dosage, condition being treated:
List all surgical procedures you have had:
Back
Next
Consent Form
Agree and sign to the following
I have informed PrimeHRT of any known allergies to medications, other substances and have provided a list of all current medications and supplements. I have fully informed PrimeHRT of my medical history.
*
Agree
Disagree
IV infusion therapy and any claims made about these infusions have not been evaluated by the FDA and are not intended to diagnose, treat, cure or prevent any medical disease. These IV infusions are a supplement to your healthcare providers care.
*
Agree
Disagree
I understand that I have the right to be informed of the procedure and the risks andbenefits. I am giving my informed consent.
*
Agree
Disagree
I understand that the procedure involves inserting a needle into a vein and injectionsolution with or without vitamins.
*
Agree
Disagree
I understand that there are risks of intravenous therapy that include but not limited to:* Occasionally: discomfort, bruising and pain at insertion site.* Rarely: inflammation of the vein phlebitis, metabolic disturbances, and injury.* Extremely rare: severe allergic reaction, anaphylaxis, infection, cardiac arrest ordeath.
*
Agree
Disagree
I understand the benefits include but not limited to: Injectables are not affected by stomach, or intestinal absorptions. Total amounts of infusions are available to the tissues.Nutrients are forced into cells by means of a high concentration gradient. Higher dosesof nutrients can be given than possibly by mouth without intestinal irritation.
*
Agree
Disagree
I am aware that other foreseeable complications could occur. I do not expect revive to anticipate and or explain all risk and possible complications, I rely on revive to exercise judgment during the course of treatment with regards to my procedure. I understand the risks and benefits of all the procedures and have had the opportunity to have all my questions answered.
*
Agree
Disagree
My signature below confirms that: I understand the information provided on this form and agree to all the statements made above. Intravenous Infusion therapy has been adequately explained to me. I have received all the information and explanation I desire concerning the procedure. I authorize and give consent to the performance of Intravenous infusion therapy. I release PrimeHRT and all staff at PrimeHRT from all liabilities for any complications or damages associated with my Intravenous infusion therapy.
*
Agree
Disagree
Signature
*
Back
Next
Submit
Submit
Payment Methods
Please click one of the PayPal options to complete payment and
submit
the form.
Should be Empty: