WAIVER AND CONSENT TO TREATMENT FOR VYTALITY BLU HEALTH & MEDSPA

Patient Information Name:

DOB:

Address:

Phone Number:

Provider Information Name:

Address:

Phone Number:

CONSENT TO IV HYDRATION TREATMENT:
I, the undersigned patient, voluntarily consent to receive treatments at the above-named clinic, under the supervision of trained medical professionals.
I acknowledge that the treatment may involve the administration of fluids, vitamins, minerals, and other nutrients through an IV or an intramuscular injection. I understand that the specific IV treatment to be provided will be discussed with me prior to the procedure, and I will have the opportunity to ask questions.

POTENTIAL RISKS AND SIDE EFFECTS:
I am aware that, as with any medical treatment, there may be risks associated with IV hydration therapy. These risks may include, but are not limited to, the following:

- Pain or discomfort at the injection site
- Infection at the needle insertion site
- Bruising or swelling at the treatment site
- Allergic reactions to fluids, vitamins, or minerals used in the therapy
- Vein, skin or muscle irritation or inflammation
- Fluid overload, especially in individuals with heart or kidney conditions

I understand that the risks listed above are not exhaustive, and that unforeseen complications may arise during or after the procedure.

VOLUNTARY NATURE OF CONSENT:
I understand that my participation in this treatment is entirely voluntary. I have the right to refuse or discontinue the treatment at any time without penalty. However, I acknowledge that this may impact the effectiveness of my treatment plan, and I have been informed of the potential consequences of not proceeding with the treatment.

WAIVER OF LIABILITY:
I, the undersigned, hereby release, waive, and hold harmless the provider, clinic, and its staff from any and all claims, damages, or liabilities arising from my participation in this elective treatment, except for those arising from gross negligence or willful misconduct.

For good and valuable consideration, which is hereby acknowledged, customer expressively disclaims and waives all representations and warranties, made by the company relating to any services provided by the company to the customer. Customer acknowledges the company, makes no representation as to a given result, timing, or appropriateness, or utility of the services delivered, and or the efficacy of same and or whether such services or deliverables will continue to have a utility if such services have Ever had any utility. Customer understands and acknowledges that the company has made no guarantee of any present or continuous results or performance that any disruptions or failures will not occur or that any service of deliverables will be free from disruption or failures or that the services and deliverables will work with any other processes.