Elective IV Hydration Therapy Consent Form

Elective IV Hydration Consent Form

This form provides important information about elective IV hydration therapy offered at Flex Health and documents your informed consent to receive treatment. It explains the purpose of IV hydration, how the procedure is performed, the potential benefits, and the possible risks or side effects associated with intravenous fluids and vitamin supplementation. The form also outlines alternatives to treatment, financial responsibility, and your rights as a patient. Before receiving IV therapy, patients are asked to review this information carefully, disclose relevant medical history, and confirm that they understand the procedure and have had the opportunity to ask questions. Signing this form indicates that you voluntarily consent to receive elective IV hydration therapy administered by qualified medical staff at Flex Health.

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Elective IV Hydration Therapy Consent*

1. Purpose of IV Hydration Therapy Intravenous (IV) hydration therapy involves the administration of fluids, vitamins, minerals, and/or medications directly into the bloodstream through a vein. The purpose of this therapy may include: • Hydration support • Electrolyte replacement • Vitamin supplementation • Wellness support • Recovery from fatigue, travel, exercise, or dehydration This therapy is considered elective and not medically necessary in many cases. ⸻ 2. Nature of the Procedure A trained medical professional will insert a small IV catheter into a vein, usually in the arm or hand. Fluids and selected additives may be administered through the IV over approximately 30–60 minutes, depending on the treatment selected. The IV solution may include: • Sterile saline or lactated fluids • Vitamins (such as Vitamin C, B-complex, B12) • Minerals (such as magnesium) • Antioxidants or other supplements The exact formulation will be discussed with you prior to administration. ⸻ 3. Potential Benefits Potential benefits may include: • Improved hydration • Temporary improvement in fatigue or wellness • Replenishment of vitamins or electrolytes Results are not guaranteed, and responses vary between individuals. ⸻ 4. Possible Risks and Side Effects Although IV hydration therapy is generally well tolerated, possible risks include: • Pain, bruising, or irritation at the injection site • Infection • Inflammation of the vein (phlebitis) • Bleeding • Dizziness or lightheadedness • Allergic reaction to vitamins or additives • Fluid overload • Electrolyte imbalance • Nausea or headache Rare complications may include: • Severe allergic reaction (anaphylaxis) • Blood clot formation • Injury to surrounding tissue • Fainting Emergency care may be required in rare circumstances. ⸻ 5. Medical Disclosure I understand that I must inform the medical staff if I have: • Kidney disease • Heart disease or heart failure • High blood pressure • Diabetes • Liver disease • Pregnancy or possibility of pregnancy • Allergies to medications or vitamins • History of adverse reactions to IV therapy • Any current medications or supplements Failure to disclose medical conditions may increase risks. ⸻ 6. Alternatives Alternatives to IV hydration therapy include: • Oral hydration (water, electrolyte beverages) • Oral vitamin supplementation • No treatment ⸻ 7. Financial Responsibility I understand that elective IV hydration therapy is not typically covered by insurance, and I agree to pay for services rendered at the time of treatment. ⸻ 8. Voluntary Participation I understand that participation in IV hydration therapy is voluntary, and I may decline or discontinue treatment at any time. ⸻ 9. Consent I acknowledge that: • I have read and understood the information above. • I have had the opportunity to ask questions, and my questions have been answered to my satisfaction. • I understand the risks, benefits, and alternatives. • I consent to receive IV hydration therapy administered by the medical staff at Flex Health. ⸻ 10. Emergency Consent In the unlikely event of an emergency related to treatment, I authorize the medical staff to provide appropriate medical care and activate emergency services if necessary.

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Brooke Gedrick D.O. board certified in emergency medicine and sports medicine, Head of weight loss clinic and aesthetic medicine to include, body sculpting, laser skin care, laser hair removal, and non-invasive face lifts.

Elective IV Hydration Consent Form

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