Terms, Conditions & Consent for IV Hydration Therapy
Our hydration therapy is specifically designed to counteract symptoms of dehydration, fatigue, and the residual effects of
nutrients and H2O depletion.
We may offer diagnostic testing with these services, however you will have to schedule an appoitment for a medical consultation. Minneapolis Health Clinic reserves the right to refuse service to any patients we deem are intoxicated unstable, or whose symptoms are not consistent with the above.
The vast majority of our clients receiving our therapy feel greatly improved; however, every individual is different and there is
no guarantee that you will feel better after an infusion; nor does your improvement of symptoms exclude other coexisting
potential medical conditions.
This document is designed to serve as confirmation of informed consent for IV therapy as by the qualified staff present at the current location.
I have informed the staff of any known allergies to drugs or other substances, or of any past reactions to anesthetics.
I have informed the staff of all current medications and supplements I am taking.
I understand that I have the right to be informed of the procedure, any feasible alternative options, and the risks and
benefits. Except in emergencies, procedures are not performed until I have had an opportunity to receive such information
and give my concerns.
I understand that the procedure involves inserting a needle into a vein and injecting the selected solution.
Risks of intravenous therapy include, but are not limited to: discomfort, bruising, and pain at the site of injection.
Other rare but possible side effects include but are not limited to: inflammation of the vein used for injection, phlebitis, metabolic disturbances, and injury.
Nutrients are absorbed into the cells by means of a high concentration ingredient.
I understand the information provided on this form and agree to the terms and policies.
I have received all the information and explanation I desire concerning the procedure.
I authorize and consent to the performance of the procedures(s).