I understand that IV (intravenous) therapy involves the delivery of fluids, vitamins, minerals, and/or other additives directly into my bloodstream through a needle placed in a vein. I understand the purpose of my infusion is to support hydration, nutrient repletion, and general wellness, and that it is not intended to diagnose, treat, cure, or prevent any disease.
I understand that, as with any procedure involving needle placement and infused substances, there are potential risks and side effects, including but not limited to: pain, bruising, or bleeding at the injection site; infiltration or extravasation (fluid leaking into surrounding tissue); vein irritation or phlebitis; infection at the injection site; lightheadedness, dizziness, or fainting; nausea; a metallic taste during infusion; and allergic reaction, which in rare cases can be severe. I understand that patients with certain heart, kidney, or other medical conditions may be at higher risk of complications such as fluid overload, and that I am responsible for disclosing my full medical history in the screening section of this form.
I understand that alternatives to IV therapy include oral hydration and oral vitamin or mineral supplementation, and that I have had the opportunity to discuss these alternatives with the clinical team before treatment.
I understand a member of the clinical team will review my health screening answers and current medications before my infusion, and that treatment may be modified, delayed, or declined based on that review. I understand I may stop my infusion at any time by notifying the clinician monitoring my visit.
I certify that the information I have provided is accurate and complete to the best of my knowledge, and I voluntarily consent to receive IV therapy at RegenOrtho Palm Beach.
Acknowledgment
I acknowledge and agree to the above statement *
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