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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This field is for validation purposes and should be left unchanged.

Gift Certificates

Send the Gift of Wellness

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Please complete this form one time per Gift Certificate.
Your Name(Required)
Your Email(Required)
Name of Recipient(Required)
Email of Recipient(Required)

Get 10% off

Your first Treatment

& Enjoy Mobile IV Therapy in the comfort of your Home