Form

This form is intended to provide you with an overview of your treatment, to explain the risks and possible side effects of such treatment, to ensure that treatment is appropriate, and obtain your consent for treatment.  Please read through this form in its entirety and complete it to the best of your knowledge prior to receiving any treatment. If you have any questions regarding the information in this form, please consult with your infusion nurse or physician prior to receiving treatment. 

About the Procedure

Intravenous (“IV”) therapy is the administration of fluids, medications, vitamins, and/or minerals directly into the bloodstream. This is done by inserting a needle or cannula into a vein (typically in the forearm, wrist, or back of the hand).

Your body normally absorbs nutrients slowly over the course of time. However, IV therapy allows your body to rapidly absorb nutrients at higher doses. This can lead to quick hydration and replenishment of vital nutrients, making it particularly beneficial for individuals seeking immediate relief from dehydration, fatigue, or nutrient deficiencies. Moreover, elective IV therapy can be customized to individual needs, allowing for tailored solutions to support overall wellness, boost energy levels, and enhance recovery after strenuous activities or illness. The infusion procedure typically takes 30 to 45 minutes.

Prior to your treatment, a Fab Fusion nurse or affiliated physician/nurse practitioner will discuss your health goals and your medical history with you. If you have any serious medical conditions, then you may be required to provide physician clearance prior to receiving IV therapy.

IV therapy and any claims made about IV infusions have not been evaluated by the US Food and Drug Administration (FDA) and are not intended to diagnose, treat, cure, or prevent any medical disease. IV therapy is not a substitute for your physician’s medical care.

Potential Risks

Potential risks of IV therapy may include, but are not limited to: mild to moderate discomfort, pain, bruising at injection site, infection at injection site, damage to blood vessels, swelling at or around injection site, inflammation of veins, dizziness or fainting, changes in blood pressure or blood sugar during or after treatment, fluid overload, electrolyte imbalance, bleeding, allergic reaction, skin necrosis, warming or burning sensation at the site of injection, thrombophlebitis or venous thrombosis, air embolism, general malaise or fatigue post treatment, fever, nausea, and in extremely rare cases anaphylaxis.

Contraindications

You should not have elective IV therapy done if you:

-Have severe dehydration requiring immediate medical attention

-Are allergic to components commonly used in IV solutions

-Have any medical condition that may be made worse by IV therapy, including without limitation, congestive heart failure, severe kidney disease, or electrolyte imbalances

-Have a known blood clotting disorder or a history of thrombosis

-Have untreated or uncontrolled hypertension (high blood pressure)

-Have heart failure or severe cardiac disease

-Have liver disease or liver failure

-Are pregnant or breastfeeding

-Have an active infection

-Have undergone recent surgery or trauma involving the veins or circulatory system

-Have any other significant medical condition

 It's important for individuals with these contraindications to consult with their healthcare provider before undergoing IV therapy to ensure safe and appropriate treatment options.

Alternative Treatments

Elective IV therapy is a strictly voluntary treatment. The treatment is not necessary or required. The alternative forms of treatment include not undergoing the IV infusion procedure, oral supplementation, and/or dietary and lifestyle changes.

Post Treatment

After your treatment is complete you should:

1. Apply pressure to the site for at least two minutes after the IV is removed.

2. Keep the bandage in place for at least one hour.

3. You may use warm packs and elevate your arm to reduce discomfort and promote healing.

4. You may use cold packs for pain relief and to reduce swelling.

5. Stay hydrated by continuing to drink water.

6. Contact us or your primary care physician if you experience any concerning symptoms or if certain symptoms worsen post-treatment, including significant swelling, increasing redness over the vein, persistent vein/arm pain, or headaches that are unresponsive to hydration or over-the-counter pain relievers.

7. If you experience life-threatening symptoms or an emergency, call 911 immediately.

Results

Elective IV therapy offers a range of potential results. One primary outcome is enhanced hydration, which allows for increased energy, mental clarity, and overall feeling of wellbeing. IV therapy also delivers essential vitamins, minerals, and antioxidants directly into the bloodstream, which promotes optimal nutrient levels in order to support various bodily functions. This infusion of nutrients can result in increased energy levels, improved mood, and enhanced cognitive function. IV therapy may also help with detoxification by flushing out toxins and waste products from the body and contributing to a revitalized feeling.

Most patients feel better immediately after treatment. However, some patients may temporarily feel tired or unwell due to the detoxification process.

It is important to note that while many individuals experience positive effects from IV therapy, results are not guaranteed and can vary depending on factors such as lifestyle, diet, and overall health status. For some people, achieving desired outcomes may require multiple treatments to sustain the benefits over time. Therefore, regular sessions of IV therapy may be recommended as part of a holistic approach to health and wellness maintenance. Consulting with a healthcare provider can help determine the most suitable treatment plan to optimize results based on individual needs and goals.

Cost

Elective IV therapy procedures require payment at the time of service. They are not reimbursable by government or private healthcare insurance providers.

Please inital next to each statement:

Waiver and Release of Liability

I voluntarily and fully assume all risks, regardless of severity, that I may sustain in connection or associated with the elective IV therapy treatment. I, for myself and my heirs, assigns, personal representatives, and next of kin, expressly waive and release any and all claims, now known or hereafter known, against the IV Clinic and their successors, assigns, employees, contractors, officers, directors, agents, affiliates, subsidiaries, and parent company, each and all of them (collectively, the "Releasees"), on account of personal injury or property damage arising out of or relating to elective IV therapy treatment. I will not to make or bring any such claim against any Releasee, and forever release and discharge all Releasees from any and all liability under such claims. All matters arising out of or relating to this waiver and release will be governed by and construed in accordance with the laws of the State of the IV Clinic’s address as listed on page 1 of this Intake and Consent Form (the “State”), without giving effect to any choice or conflict of law provision or rule. Any claim or cause of action arising under this waiver and release may be brought only in the federal and state courts located in the city and State of the IV Clinic’s address as listed on page 1 of this form, and I consent to the exclusive jurisdiction of such courts. I understand that this waiver and release is intended to be as broad and inclusive as permitted by law and that if any portion hereof is held invalid, I agree that the remainder will continue in full legal force and effect. I further agree that if this waiver and release is not valid as such in the State, then it will be construed as a covenant not to sue.  

 I acknowledge that at the time of signing this form, I am of sound mind and capable of making independent decisions for myself.

I HAVE READ THIS WAIVER AND RELEASE AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I AM SIGNING THIS WAIVER AND RELEASE VOLUNTARILY.