CONSENT TO TREAT WAIVER

CONSENT TO TREAT WAIVER

Vytality Blu Health & Medspa

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Patient Information

CONSENT TO IV HYDRATION TREATMENT:

I, the undersigned patient, voluntarily consent to receive treatments at the above-named clinic, under the supervision of trained medical professionals.


I acknowledge that the treatment may involve the administration of fluids, vitamins, minerals, and other nutrients through an IV or an intramuscular injection. I understand that the specific IV treatment to be provided will be discussed with me prior to the procedure, and I will have the opportunity to ask questions.


POTENTIAL RISKS AND SIDE EFFECTS:

I am aware that, as with any medical treatment, there may be risks associated with IV hydration therapy. These risks may include, but are not limited to, the following:


- Pain or discomfort at the injection site

- Infection at the needle insertion site

- Bruising or swelling at the treatment site

- Allergic reactions to fluids, vitamins, or minerals used in the therapy

- Vein, skin or muscle irritation or inflammation

- Fluid overload, especially in individuals with heart or kidney conditions


I understand that the risks listed above are not exhaustive, and that unforeseen complications may arise during or after the procedure.

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VOLUNTARY NATURE OF CONSENT:

I understand that my participation in this treatment is entirely voluntary. I have the right to refuse or discontinue the treatment at any time without penalty. However, I acknowledge that this may impact the effectiveness of my treatment plan, and I have been informed of the potential consequences of not proceeding with the treatment.


WAIVER OF LIABILITY:

I, the undersigned, hereby release, waive, and hold harmless the provider, clinic, and its staff from any and all claims, damages, or liabilities arising from my participation in this elective treatment, except for those arising from gross negligence or willful misconduct.


For good and valuable consideration, which is hereby acknowledged, customer expressively disclaims and waives all representations and warranties, made by the company relating to any services provided by the company to the customer. Customer acknowledges the company, makes no representation as to a given result, timing, or appropriateness, or utility of the services delivered, and or the efficacy of same and or whether such services or deliverables will continue to have a utility if such services have Ever had any utility. Customer understands and acknowledges that the company has made no guarantee of any present or continuous results or performance that any disruptions or failures will not occur or that any service of deliverables will be free from disruption or failures or that the services and deliverables will work with any other processes.


Customer waves any in all claims for recovery based upon future events, or results happening, or not happening, as intended, or otherwise expected by the customer it is hereby agreed and acknowledged that the company has made no representation whatsoever that any result would or will not occur by the virtue of receiving or otherwise, following from the services delivered to customer Any supplements, services or deliverables provided to or requested by customer are determined by the customer and the company makes no guarantee with respect to the efficacy or health benefit of any such supplements, services or deliverables. Customer hereby waives any and all rights to the claims for personal injuries, damages, wrist, adverse effects, medical or other clinical conditions that are sustained, or that might otherwise arise out of any services or deliverables provided by the company. Customer further waives all rights to a jury trial. All incidental, indirect or consequential damages, lost income, or the like arc Presley waved by the customer. Customer liability shall be limited to the cost of the services. The customer is claiming they were defective or caused harm. No further liability shall apply to the company in the event of a claim by a customer that the service is rendered by the company or the product requested by the customer or somehow deficient or cause any physical, mental, or other injury, harm, loss or damage. The company has not engaged in the practice of medicine, does not provide medical services, and is not a healthcare provider. The healthcare professional with which you established a treatment relationship is so responsible for providing you with the medical services, The nurses and nurse practitioners in our establishment are under the supervision of a licensed medical doctor that serves as our medical director. We act as a platform to connect you with healthcare professionals who may be interested in providing you with the services you are determining are appropriate for yourself and the products we offer you.


FINANCIAL AGREEMENT:

I agree to pay all fees associated with the treatment as outlined by the clinic. I understand that these fees may not be covered by insurance, and I am responsible for the full cost of the service unless other arrangements have been made.


ACKNOWLEDGEMENT AND SIGNATURE:

By signing below, I acknowledge that I have read and understood the information provided in this waiver and consent form. I have had the opportunity to ask questions and have received satisfactory answers. I consent to receiving the IV hydration therapy and agree to the terms outlined above.

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