I understand that participating in intravenous (IV) hydration, vitamin/supplement administration, pharmaceutical administration, programs and services made available by IV Oasis carries risks.
I ACKNOWLEDGE AND AGREE THAT THE SOLE RISK OF INJURY OR HARM RESULTING IN ANY MANNER FROM MY CHOOSING TO PARTICIPATE IN SUCH REGIMEN, PROGRAM AND SERVICES RESTS ENTIRELY WITH ME TO THE EXTENT THAT I DO NOT DISCLOSE MY HEALTH CONDITION, MEDICATIONS OR DRUG USE IN ADVANCE.
I expressly represent and warrant to IV Oasis that I have never been diagnosed with nor treated for any disease, illness or condition which may result in increased risk when I participate in regimens, programs or services made available by IV Oasis, and I am not choosing to participate with any expectation that IV Oasis will screen for, diagnose, monitor or otherwise provide any care or treatment for such condition.
I acknowledge and understand that IV Oasis is relying upon accurate representations and warranties from me upon IV Oasis’ acceptance of me for participation in its IV infusion programs and services.
I have been informed of the following:
The nature of the treatment, including other care, treatment or medications.
Potential benefits, risks or side effects of the treatment or procedures
The likelihood of achieving treatment goals
Reasonable alternatives and the relevant risks, benefits and side effects related to such alternatives including the possible results of not receiving care or treatmetnt
Risks are rare but are as follows:
Bleeding at infusion site infection, inflammation/swelling, bruising or scarring resulting from IV infiltration, extraction and extravasation
Misplacement of IV lines in the body, air embolism
Allergic reaction to infusion ingredients
ACKNOWLEDGEMENT: I confirm that I have read this form and fully understand its contents. I acknowledge that no guarantees or assurance have been made to me concerning the results intended from the sessions and programs offered by IV Oasis. I understand the nature of the sessions and programs and that participating in them carries risks. I have been given an opportunity to ask questions, and all of my questions have been answered fully and to my satisfaction. I agree to my assumption of all risks associated with my participation. I consent to the infusion service provided by IV Oasis.