I hereby consent to receive Intravenous (IV) Therapy at Fusion Wellness. I understand that IV Therapy involves the infusion of fluids, vitamins, minerals, amino acids, or other approved nutrients directly into my bloodstream for the purposes of hydration, recovery, wellness, and/or performance optimization.
I acknowledge that while IV Therapy can have potential benefits — including improved energy, recovery, immune function, hydration, and overall well-being — results are not guaranteed and may vary between individuals.
I understand that potential risks and side effects may include, but are not limited to: pain, bruising, redness, or swelling at the infusion site; infection; vein irritation (phlebitis); allergic reaction; dizziness; nausea; or lightheadedness. I understand that in rare cases, complications may require medical attention.
I agree to inform staff of all current medications, supplements, and medical conditions, including any history of heart, kidney, or liver disease, before treatment. I understand that Fusion Wellness reserves the right to decline or postpone treatment if staff determine that IV therapy may not be appropriate or safe for me at that time.
I understand that IV Therapy is not a substitute for medical diagnosis or treatment, and I am encouraged to maintain regular care with my primary healthcare provider. I voluntarily assume all risks associated with this therapy and release Fusion Wellness, its staff, contractors, and affiliates from any and all liability arising from participation in IV Therapy sessions, including any adverse reaction or complication.
I have had the opportunity to ask questions regarding IV Therapy, its risks, and benefits, and all of my questions have been answered to my satisfaction. I consent voluntarily to treatment and understand that I may discontinue therapy at any time.
⚠ Important: Please notify staff immediately if you experience any pain, swelling, dizziness, shortness of breath, or unusual sensations during your IV session. Do not drive immediately after treatment if you feel lightheaded.
Please sign below using your finger (mobile/tablet) or mouse (desktop):
Your information is kept strictly confidential and used solely for treatment purposes.