At KX Yorkville, we are committed to delivering safe, professional, and high-quality IV Therapy and Annual Active Care services. To ensure mutual understanding, patient safety, and legal compliance, we require all clients to review and acknowledge the following terms prior to receiving care.
1. Privacy Policy
KX Health Inc. complies with Ontario’s Personal Health Information Protection Act (PHIPA, 2004). We collect only the necessary health information for the delivery of IV Therapy services and use it solely for the purpose of providing treatment. Your Personal Health Information (PHI) will be handled securely and confidentially.
2. Nature of Service
IV Therapy are supportive wellness services. While many clients report improved energy, hydration, immunity, and metabolic insights, these services are not diagnostic and are not a substitute for conventional medical care. We do not provide medical diagnoses or treatment for specific conditions. KX reserves the right to decline treatment or testing services if symptoms fall outside the scope of our practice, or if a client is deemed medically unsuitable.
You understand:
- Individual results may vary.
- Functional blood chemistry interpretations are designed to support health optimization—not diagnose or treat disease.
- If symptoms persist or worsen, you should seek immediate medical attention.
3. Consent to Treatment
By signing this Agreement, you confirm that:
- You have disclosed your full and accurate medical history.
- You are not under the influence of alcohol or recreational substances.
- You understand potential risks and side effects including but not limited to: bruising, bleeding, pain, infection, swelling, allergic reactions, vein irritation, vasovagal response, or reactions to nutrients.
- You understand that IV infusions require your presence in the facility throughout the treatment unless paused or terminated.
- You have had the opportunity to ask questions and all your concerns have been addressed.
4. Emergency Contact & Primary Care
For your safety, we collect the following:
- Emergency Contact Name & Phone Number
- Family Doctor Name & Contact (if available)
5. Email Communication Consent
You consent to receive communication from KX Yorkville, including:
- Health intake forms and assessments
- Bloodwork requisitions and lab instructions
- Functional chemistry analysis reports
- Follow-up communication and program updates
You understand that these communications may contain personal health information and will be sent securely via encrypted email systems where applicable.
5. Credit Card Authorization
Sales Transactions: Any sales transactions made with KX will be charged to the credit card on file unless alternative payment arrangements have been made.
Security and Confidentiality: All credit card information provided to KX will be securely stored and encrypted to ensure confidentiality, in compliance with industry standards and regulations.
Authorization: By providing your credit card information to KX, you authorize us to charge the card on file for the purposes outlined in this policy.
Updating Card Information: It is the responsibility of the client to ensure that the credit card information on file is accurate and up to date. Please inform us promptly of any changes or updates to your card details.
Notification of Charges: Clients will receive notification of any charges made to their credit card on file, including details of the transaction and the amount charged.
6. Cancellation Policy
To maintain the efficiency of our services and to honor the commitments of our practitioners, we enforce a 24-hour cancellation policy. We kindly ask that you notify us of any appointment cancellations at least 24 hours in advance. Failure to provide adequate notice may result in a charge equivalent to the session fee.
Credit Card Requirement: We require a credit card on file prior to booking any appointments. This ensures that we can uphold our cancellation policy effectively and secure the practitioner's time for your appointment.
7. Entire Agreement
By signing this document (the “Agreement”) you will waive certain legal rights, including the right to sue or claim compensation following an accident to KX Health Inc. operating as “KX” and its directors, officers, employees, representatives, independent contractors, volunteers and successors and assigns (collectively the “Operator”).
Assumption of Risks: I am aware that receiving services from KX (the “Services”) at its facilities (the “Facilities”) involves many risks, dangers and hazards, including, but not limited to: mechanical failure of equipment used; lack of adequate protective equipment and inadequate safety measures; slipping and/or falling in the Facilities; negligence of you or other customers of Operator; pain; bleeding; bruising; blood clots; infection; local soft tissue injury; fluid overload; shortness of breath; swelling; electrolyte imbalances; changes in vital signs; itching and/or swelling of the lips, tongue and throat; nerve injury; allergic reaction (including to nickel or sulfa antibiotics); risk of iatrogenic adrenal insufficiency; risk of vasovagal response or “fainting”; other undefined harm or damage which is not readily foreseeable and other presently unknown risks or dangers; and negligence on the part of the Operator. I understand that negligence includes failure on the part of the Operator to take reasonable steps to safeguard or protect me from the risks, dangers and hazards of the Services.
Acknowledgements: By signing this Agreement, I hereby represent and warrant to Operator (or agree with Operator, as the case may be) that: I am aware of the risks, dangers and hazards associated with the Services and you freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury, death, property damage and loss resulting therefrom; I am at least 18 years of age; I will comply with the reasonable instructions of the Operator provided to me from time to time; The Operator may refuse to provide the Services to me in its sole discretion; I am not, at the time of receiving the Services, intoxicated or under the influence of any mind-altering substance; If I am receiving Services containing “Glutathione”, I do not have an allergy to sulfa antibiotics; There is no medical or physical reason of which I am aware as to why participation in the Services could potentially be harmful in any way; I have fully disclosed, to the best of my ability, my complete medical history and have answered all of the questions contained in the medical screen questionnaire honestly and completely as possible; The Operator is authorized to use my Personal Health Information (as defined in the Personal Health Information Protection Act, 2004) for the purposes of providing the Services to me, but only to the extent that such information is needed for such purposes; I have had the opportunity to consult with the Operator and ask any questions you may have regarding the services; I consent to receiving the Services; While/if I am receiving infusion treatments, I will not be permitted to leave the Facilities, including for the use of the restrooms, unless I have terminated or paused such treatments; If I am receiving IV treatments, I have received, read and/or understood the Home Care Instructions either written or verbally provided by the Operator; I should seek immediate medical assistance if any complications related to the Services arise; and The Operator has provided no guarantees as to the effectiveness of the Services.
Release of Liability: In consideration of the Operator agreeing to provide the Services to me, I hereby agree as follows: To waive any and all claims that I may have in the future, against the Operator and to release the Operator from any and all liability for any loss, damage, expense or injury including death that I or my next of kin may suffer, resulting from either my use of the Services, presence on the Facilities, or travel outside the Facilities, due to any cause whatsoever, including negligence, breach of contract, or breach of any statutory or other duty of care owed under any applicable occupiers’ liability legislation on the part of the Operator. I understand that negligence includes failure on the part of the Operator to take reasonable steps to safeguard or protect me from the risks, dangers and hazards referred to above. To hold harmless and indemnify the Operator from any and all liability for any damage to property of, or personal injury to, any person or entity resulting from my participation in the Services, or presence on the Facilities, or travel outside the Facilities; The terms of this release of this Agreement relating to waiver and indemnity shall survive termination of this Agreement. This Agreement shall be binding upon my heirs, next of kin, executors, administrators, assigns and representatives in the event of my death or incapacity. This Agreement and all aspects of your relationship with the Operator and its agents shall be governed by the laws of the Province of Ontario and the federal laws of Canada applicable therein. Any litigation involving the parties to this Agreement shall be brought solely within the Province of Ontario and shall be within the exclusive jurisdiction of the Courts of the Province of Ontario; and in entering into this Agreement, I am not relying upon any oral or written representations or statements made by Operator with respect to the safety of the Services other than what is set forth in this Agreement. Should any provision in this Agreement be deemed invalid or unenforceable by a court of competent jurisdiction, such provision will only be ineffective to the extent of that restriction and all remaining provisions or parts thereof shall remain in full force and effect. I confirm that I have read this Agreement and understand, and am aware that by signing this Agreement I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators, assigns and representatives may have against the Operator.