Liability Waiver:
Consent To Receive Drip IV Therapy Wellness Services

1. PURPOSE. 

The purpose of this form is to obtain your consent for: Health and wellness services administered by DripIV Therapy and its affiliates. These services are being provided by: DripIV Therapy and its affiliates The reason these services are being provided is: General Health and Wellness

2. NATURE OF THE SERVICES: 

The Drip IV Therapy services consist of infusions into my body through IV drip or IM injection, of minerals, vitamins, and/or other nutrients suspended in a liquid form. A needle and or a needle and a catheter will be inserted through my skin either into a muscle or a vein in order to introduce this liquid into my body.

3. RISKS, BENEFITS AND ALTERNATIVES.

The benefits of the Services include potentially: increased energy, hydration, increase in metabolism, cardiovascular support, nail, skin and hair health, and immune-system support.

The risks include:
(i) injection/venipuncture site swelling, redness, irritation, bruising, bleeding, and infection,
(ii) reaction to vitamins including fever, aches, nausea, rash, hives, wheezing, joint swelling, and general allergic reaction, and
(iii) other minor complications of IV or IM injection.

4. Non-FDA EVALUATED OR APPROVED.

I, as patient signing and consenting below, understand and acknowledge that the United States Food and Drug Administration has not evaluated or approved the treatments I am about to receive to diagnose, treat, cure, or prevent any disease. The FDA might in fact recommend other treatments.

5. JUDGMENT AND CHANCE TO ASK QUESTIONS

In giving the consent hereunder, I, as patient, am relying on the judgment of the clinical professional evaluating me and administering the treatments. I have had the meaningful chance to ask questions and have received satisfactory answers to my questions. The risks and potential benefits of the treatment I am consenting to have been explained to me. Alternatives to the treatments I am consenting to have also been discussed with me.

CONSENT:

In considering all of the factors above, including risks, benefits and potential adverse results and reactions, and based on my conversations with my clinical professional about the same and alternative therapies, I hereby consent to examination, treatment, and IV therapies as listed above, including the placement of IV catheters or IM injections into and through my skin and/or veins and muscles by Dr. Paul Song or the clinical professionals working under his direction.