Informed Consent
Medical consent document for IV therapy services.
Please read this document carefully. By signing, you acknowledge that you have understood the nature of the procedure, its risks, and your rights as a patient.
INFORMED CONSENT FOR INTRAVENOUS (IV) THERAPY
I, the undersigned, consent to receive intravenous (IV) vitamin and mineral therapy administered by a licensed nurse of Mobile IV Therapy.
I understand that:
1. IV therapy involves inserting a needle into a vein to deliver fluids, vitamins, and minerals directly into the bloodstream.
2. Potential risks include bruising, discomfort, infection at the insertion site, allergic reactions, and in rare cases, more serious reactions.
3. I have disclosed all relevant medical information in the health questionnaire.
4. I may withdraw consent at any time during the procedure.
5. This service does not replace medical treatment or the care of a licensed physician.
6. In case of adverse reaction, Mobile IV Therapy staff will provide initial care and, if necessary, facilitate emergency medical assistance.
By signing below, I confirm that I have read, understood, and voluntarily consent to this procedure.
To sign this consent, you must do so during the scheduling process.
Schedule