I understand that these therapies involve inserting of a needle/catheter into either the vein or muscle. I understand that it is my responsibility to notify the staff of any burning, pain, or adverse reaction that I may be experiencing. I understand that with IV therapy it is possible that if the catheter becomes dislodged or infiltrated that it may cause swelling, pain or discomfort at the site however, this is not dangerous to me or my health and that the fluids will absorb and the swelling and tenderness will subside.
I understand that there is no implied or stated of guarantee of success or effective of any specific treatment.
Alternatives to IV/IM therapy include oral supplementation, lifestyle and dietary changes I am aware that unforeseeable complications could occur and that IV Me Now mobile IV van/ staff is and are not an ambulance service nor equipped to handle life-threatening emergencies. If the event of any unforeseen severe reaction, 911 will be notified. I understand that I have the right to consent to or refuse any proposed treatment at any time prior to its performance. My signature on this form affirms that I have given my consent to IV/IM therapy.
