Guardian Cup '26

Patient Info
Name*

First NameLast Name
Email*
example@example.com
Birth Date*

MonthDayYear
Medical Screening
Please check ALL that apply:*

Pregnancy or possibly pregnantKidney diseaseHeart disease or heart failureLiver diseaseHigh blood pressure not controlledOn blood thinnersHistory of adverse reaction to IV therapyNone of the above
Medication Allergies (short answer):
SECTION 3: CURRENT STATUS
Last time you ate*

<2 hrs2-4 hrs>4 hrs
Current symptoms (check all that apply):*

FatigueMuscle sorenessDehydrationHeadacheNauseaHangover symptomsNone
Section 4: RN ONLY

My Products

DepositCancellations made by March 1, 2026 at 3:00 PM are eligible for a full refund.

$25.00

Total

$0.00

Credit Card

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ACH Bank Transfer

Final Review & Sign
Section 5: Consent Statement & Patient Signature:
CONSENT FOR TREATMENT: I voluntarily consent to the administration of IV hydration and vitamin therapy. I understand that while IV therapy is generally safe, risks include bruising, inflammation of the vein, and rare allergic reactions.

ATHLETIC WAIVER: I acknowledge that I am participating in a high-intensity athletic tournament. I have disclosed all medical conditions and medications truthfully. I understand that IV therapy is a wellness service and does not replace medical treatment for underlying conditions.

I confirm that I am not currently experiencing chest pain, shortness of breath, or severe allergic symptoms.
Confirmation*

I have read the above and agree to the terms of service.
Signature*

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Date*

MonthDayYear
Date
Hour MinutesAM/PM Option

Patient Info