IV Hydration Therapy Enrollment Form

Our IV Infusion Options
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Quench (Rehydrate) Hydrate and combat fatigue from dehydration
$250.00 Quantity



Get-up-and-go (Boost)Burn fat, feel energized and boost your metabolism
$250.00 Quantity



Recovery and performance (Enhance)Decrease recovery time and enhance your performance
$300.00 Quantity



Immunity (Be well)Boost your immune system, feel better faster
$250.00 Quantity



Alleviate (Relief)Minimize bloating, irritability, abdominal discomfort and lower back pain
$250.00 Quantity



Inner Beauty (Glow)Fight acne, wrinkles and tired skin from the inside out
$300.00 Quantity



Myer's Cocktail (Wellness)"Gold Standard" for overall wellness
$250.00 Quantity



NAD + (Clarity)Mental clarity, anti-aging support
$250.00 Quantity



Reboot (Relief)Ease hangover headache, nausea and dehydration
$250.00 Quantity



Total

$0.00

Please consent to the following:

During the treatment, despite all the precautionary measures made by the professional injury is possible. If I experience any pain or discomfort during the session, I will immediately inform the healthcare professionals.I consent to the insertion of a peripheral intravenous catheter (Cannula) and to the infusion of fluids, vitamins, mineral and/or medications. I agree and acknowledge that no promises or guarantees were made regarding the efficacy of the infusion.I understand a Cannula will need to be inserted into my skin to gain access to the vein by the Healthcare Professional. My Healthcare Professional will have full competency in inserting a Cannula, removing a Cannula, monitoring and caring for the Cannula and administering Intravenous vitamins, minerals and/or medications.I understand that there are risks associated with IV Therapy, if any sort of reaction occurs I will seek medical attention and inform my Healthcare Professional.I understand and agree to the aftercare instructions provided by the Healthcare Professional. By not following the aftercare instructions I am aware that the desired results may not be achieved.I understand that there is a high risk of bruising to the Cannula site where the administration takes place.I understand that clients must be ambulatory and not actively vomiting at the time of their scheduled appointment..The Healthcare professional performing the procedure will not be held liable for and damages caused to me or my skin by any reason, including allergic reaction, skin sensitivity, and failure to follow the after care instructions.I have declared all relevant history, and if any changes occur in the future I will notify the healthcare team.
Client Signature

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