Membership Agreement Form
  • Membership Agreement Form

    Complete this form to enroll in a VITALITY membership and authorize automated billing. Please read and agree to the terms before signing.
  • Monthly Memberships

    Monthly membership options and billing details are listed here for review before enrollment.
  • Silver Membership - $100/month

    Includes 1 (one) 1L Hydroquench infusion. 10% off all other services. (maximum of 5 of each service per month). Exclusions applied: discounts are not taken on travel charges, packages, or gift cards. No additional discounts or promo codes will be applied.

    Gold Membership - $200/month

    Includes 1 (one) Myers Cocktail infusion ($220 Value) or 1 (one) of our specialty IV infusions of the members choice along with a free add-on (excludes NAD). 10% off all other services (maximum of 5 of each service per month). Exclusions applied: discounts are not taken on travel charges, packages, or gift cards. No additional discounts or promo codes will be applied.

    Platinum Membership - $250/month

    Includes 1 (one) Myers Cocktail infusion ($220 Value) or 1 (one) of our specialty IV infusions of the members choice (excludes NAD) along with a free add on. 10% off all other services (maximum of 5 of each service per month). 4 sessions per month in the Red light bed for 20 minute sessions each. Exclusions applied: discounts are not taken on travel charges, packages, or gift cards. No additional discounts or promo codes will be applied

    Red light Bed Membership - $99/month

    Unlimited sessions per month in the Dahlia Red light bed.
    Recommended every other day sessions.

  • Membership Type*
  • Membership Freeze Option

    Review the available freeze-related membership information and any billing implications before continuing.
  • A membership may be frozen for a minimum of one month and a maximum of three months at participating locations. Memberships can only be frozen one time in a 12-month period for a maximum of 3 months at a time. A minimum of one EFT payment must have been made before a membership is eligible to be frozen. Freezing a membership is completely at the discretion of each individual on individual circumstances.

    • All membership benefits are for active members in good standing during the term of their membership.
    • Memberships are non-transferable and non-refundable ● Monthly infusions DO NOT carry over to the next month. Infusions are one per month for the discounted membership price, and all other services receive 10% off during the month.
    • Vitality Infusions must be notified within 15 days of any changes, including cancellation, address, contact information and/or credit card information.
    • Must have three monthly payments before cancellation of membership.
    • Guests must follow rules and regulations. Vitality Infusions reserves the right to refuse or discontinue services for any reason.
    • Vitality Infusions reserves the right to modify/change rules, regulations, services, and pricing with reasonable notice.
    • Twenty four hour advance notice is required for any appointment cancellation.

    Failure to do so will result in a fee equivalent to 50% of the cost of the scheduled infusion.

    Notice to Client: You are entitled to a copy of this Agreement at the time you sign it.

  • Initial Term Acknowledgment: The initial term of this Agreement is for a monthly period (the “Initial Term”). If this is an EFT/CC Payments Agreement, it will automatically continue in monthly increments (your “Billing Period”) after this Initial Term, with an automated billing amount of Text

  • Automated Billing Amount*
  • until you notify 15 days before EFT/CC withdraw notice of termination as noted below, recommended via certified mail, to 1526 JACKSON STREET, FORT MYERS, FL 33901. This Agreement is for the Initial Term as herein stated. Minimum Payment Schedule: A monthly EFT/CC Payment of Text

  • Minimum Monthly EFT/CC Payment Amount*
  • Monthly Payment Start Date*
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  • Terms and Conditions

    Please read the membership terms carefully and acknowledge your agreement before signing.
  • Signatures

  • Signature Date*
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