Complete the Consent Form

Please click below to complete the medical consent to treatment form. We will email you a copy of your consent information.

Treatment Consent Form

This document is intended to serve as patient’s informed consent for medical treatment. Please check each section to give us permission to treat you.

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Get Started

with medication-assisted Weight Loss

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Gift Certificates

Send the Gift of Wellness

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Please complete this form one time per Gift Certificate.
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Get 10% off

Your first Treatment

& Enjoy Mobile IV Therapy in the comfort of your Home

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