I understand and acknowledge that I am voluntarily consenting to receive Intravenous (IV) Therapy treatment. I understand that the treatment involves the insertion of a small needle into a vein to administer fluids, medications, vitamins, or other therapeutic substances.
I acknowledge that, although IV Therapy is generally safe, there are inherent risks and potential side effects associated with this procedure. These risks include, but are not limited to:
- Infection at the needle insertion site
- Bruising or hematoma formation at the injection site
- Nausea, dizziness, or fainting
- Inflammation of the vein, resulting in pain, redness, and swelling
- Rare instances of fluid or medication leakage into surrounding tissue, potentially causing damage or discomfort
- Allergic reactions, though uncommon, may manifest as rashes, itching, swelling, difficulty breathing, and in severe cases, cardiac arrest
- Extremely rare possibility of nerve damage at the injection site
I understand that the risks and potential side effects listed above are not exhaustive, and there may be other unforeseen risks associated with the treatment. I agree that if I experience any of these side effects, I will promptly inform my provider and, if necessary, seek medical attention at my own expense. I acknowledge that it is my responsibility to disclose any health condition or medication that might impact the treatment.
By signing below, you agree to the following:
I have completed this form truthtully and to the best of my knowledge. I agree to waive a abilities toward my provider and the employer for any injury or damages incurred due any falsification of my medical history.