I hereby request and voluntarily consent to treatment with IV therapies of vitamins, and
micronutrients and placement of an IV catheter by The Scarlet Drip. I have had the opportunity
to ask questions and discuss the procedure with The Scarlet Drip to my satisfaction.
I have informed the nurse and/or provider of any known allergies to medications or other
substances and of all current medications and supplements. I have fully disclosed my entire
medical history including any prescription drugs and other supplements that I'm currently
using. I understand that I have the right to be informed of the procedure, any feasible
alternative options, and the risks and benefits.
IV/IM therapy and any claims made about these services have not been evaluated by the U.S.
Food and Drug Administration (FDA) and are not intended to diagnose, treat, cure, or prevent
any medical disease.
I understand that in the practice of IV therapy there are some risks of examination and
treatment and that the following possible complications could occur, although they are very
unlikely:
Bruising at the site where the needle is inserted.
Slight bleeding when the needle is removed.
Low risk of potential infection.
Allergic reaction to a nutrient, a needle, or other supplies.
Burning sensation at the site of the needle or in the vein that therapy is being administered through.
There is a potential for dizziness, feeling faint, or changes in blood pressure and blood sugar during or following your treatment due to some nutrients.
Other rare, but possible side effects include: fever, nausea, edema, upset stomach, difficulty breathing, arrhythmia, stroke.
