Loading
This consent form outlines the purpose, potential risks, benefits, and alternatives of intravenous (IV) therapies offered by Down-to-Earth Wellness Center (“DTE Wellness Center”). These therapies may include Vitamin IVs, Chelation Therapy, Iron Infusions, High-Dose Vitamin C, and Plaquex Therapy. Please read carefully and ask questions before signing.
Purpose and Nature of IV Therapy: I understand that the IV therapy services offered by Down-to-Earth Wellness Center are intended to support hydration, nutrient replenishment, detoxification, immune health, cardiovascular wellness, anti-aging, and overall well-being. These therapies may include Vitamin IVs to restore nutrient levels, Chelation Therapy using EDTA or other agents to remove heavy metals, Iron Infusions for medically indicated iron deficiency, High-Dose Vitamin C for antioxidant and immune support, and Plaquex Therapy designed to promote vascular health and reduce arterial plaque.
Benefits of IV Therapy: The potential benefits of IV therapy include enhanced hydration and energy, improved immune function, detoxification, removal of heavy metals, and relief of symptoms associated with nutrient deficiencies. It may also support cardiovascular health and overall vitality.
Risks and Side Effects: While IV therapy is generally safe, I understand that there are possible risks and side effects. These may include discomfort, bruising, or inflammation at the injection site, infection, phlebitis, allergic reactions, dizziness, nausea, changes in blood pressure or blood sugar, and rare injuries to nerves or blood vessels. Specific treatments such as iron infusions carry additional risks, such as iron overload or mineral imbalances. I acknowledge these risks and agree to report any side effects to the medical staff immediately.
Medical Disclosure: I have disclosed all relevant medical information to the provider, including current medications, supplements, allergies, known health conditions, and any history of heart, liver, or kidney issues. I have also informed the provider if I am pregnant or breastfeeding. I understand that withholding medical information may increase my risk of complications.
Alternative Options: I understand that alternatives to IV therapy include oral supplementation, dietary and lifestyle changes, or foregoing treatment altogether. I acknowledge that IV therapy is an elective treatment and that I am under no obligation to proceed.
Consent and Release of Liability: By signing the Consent & Authorization Summary Signature Page, I confirm that I have read and understand the information provided in this consent form. I have had the opportunity to ask questions and have received satisfactory answers. I voluntarily consent to receive IV therapy at Down-to-Earth Wellness Center under the care of licensed professionals. I understand that individual results may vary and that no specific outcomes are guaranteed. I agree to release and hold harmless Down-to-Earth Wellness Center, its providers, and affiliates from any adverse outcomes, except in cases of gross negligence or malpractice.