Concierge IV Infusion Request Form

Concierge Vitamin Infusions Request Form
At VitaLuxx, we have the option to bring the IV infusion experience to your desired location. This allows you to be comfortable and surrounded by loved ones. This is perfect for large groups who'd like to drip together. We travel to areas within Orlando and it's surrounding areas.

Please fill out this form which serves as a request to book your concierge service with us. We will contact you within the next 1-2 business days in regards to this request. To increase the likelihood of securing your desired date/time, please request at least 1-2 weeks before desired date.

Can't wait to serve you ✨
1. You are the host. Please enter your information.
Name*

First NameMiddle InitialsLast Name
Mobile Phone*
Format: (000) 000-0000.
Email*
example@example.com
Is there a gate code?
Any specific parking instructions
Let us learn more about your upcoming drip event.
What is the desired date of event*

MonthDayYear
We will do our best to accommodate your request
Street Address of Event Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Time*

We will do our best to accommodate your request

AM/PM Option
HouseHotelBusiness/Retail locationOfficeSpaOther
Just becausePre/post travelEmployee AppreciationBachelor/bacheloretteAthletic recoveryGirls nightBirthdayAfter party recoveryWeddingOther
1-2 people3 to 5 people5 to 10 people10 to 20 people20 to 50 people50 or more
Out of those people, how many people will be getting an infusion? *
18-3545-4555-6565+
The hostEach person individuallyA companyUndecided at this time
Concierge Guidelines: Our prices include the IV infusion and travel. We make the experience seamless by traveling to your location, setting up our station, providing services and disposing of our wastes.

The host can chose to pay for their party's infusions or require individual pay at the time of service. The host is responsible for this cost, which will be charged to their card at the end of event, if balance is due. The host is responsible for canceling, rescheduling, even if not attending. The host must contact us to designate a new host for this event prior to event start time.

To secure reservation, a $100 deposit must be paid by host at the time of booking event reservation which will go towards the one IV infusion, usually the Host.

For parties of 3 or more, the host automatically gets two free add ons / upgrades to their infusion as a thank you.

I understand & agree to the statements above.
Date*

MonthDayYear
Date
Should be Empty:

Concierge Vitamin Infusions Request Form

1. You are the host. Please enter your information.

Let us learn more about your upcoming drip event.