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I understand and acknowledge that I am voluntarily consenting to receive Intravenous (IV) Therapy treatment. I understand that the treatment involves the insertion of a small needle into a vein to administer fluids, medications, vitamins, or other therapeutic substances.
I acknowledge that, although IV Therapy is generally safe, there are inherent risks and potential side effects associated with this procedure. These risks include, but are not limited to:
Infection at the site of the needle insertion
Bruising or collection of blood at the injection site
Nausea, dizziness or fainting spells
Inflammation of the vein at the injection site may occur, leading to pain, redness, and swelling
In rare cases, the fluid or medication being administered may leak into the surrounding tissue, potentially causing damage or discomfort
Although rare, allergic reactions can occur, leading to rashes, itching, swelling, difficulty breathing, and in rare instances, cardiac arrest
While extremely rare, there is a remote possibility of nerve damage at the injection site
I understand that the risks and potential side effects listed above are not exhaustive, and other unforeseen risks may arise. I agree that if I experience any of these side effects, I will contact my provider and, if necessary, seek medical attention at my own expense. I understand that it is my responsibility to disclose any health condition or medication that might affect the treatment.
By scheduling a service, I confirm that I have been fully informed of the potential risks, benefits, and complications and I voluntarily agree to undergo the treatment. I have had the opportunity to ask questions, and all my concerns have been addressed to my satisfaction. I release Bliss Mobile IV from any liability or claims arising from the treatment.
Accuracy of Information
By scheduling a service, I acknowledge that I have provided complete and accurate information and understand that it will be used to assess my suitability for any treatment. I understand that it is my responsibility to inform the provider of any changes to my medical history. I agree to waive all liabilities of the provider or employer for any injury or damages incurred due to misrepresentation of my health history.
Serving all of Cache and Box Elder Counties including: Logan, Providence, Smithfield, Hyrum, Wellsville, Brigham City, Tremonton