[MY] IV Nutrition Therapy

Please enter the details below and our team will get back to you with a confirmation soon. If you have further enquiries on IV Revitalise, please contact our 24 hour hotline +60 11 4166 1178.
Patient's Details
Name*
NRIC/Passport Number*
Gender*
Date of Birth*

DayMonthYear
Email*
Appointment confirmation will be sent to this email
Contact Number
Emergency Contact Number
Do you have any allergies to any medications?*

YesNo
Please describe your allergies:*
On-Site Treatment Address*

Street Address

Floor, Unit #, Building Name etc.

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Postal CodeCountry
APPOINTMENT DETAILS
Do you have a preferred date and time for your first appointment?

YesNo, I will inform Speedoc when I am contacted.
Preferred Date & Time - [subject to availability]*
Type of Therapy

My Products

IV Revitalise Single (1 session)

349.00MYR

IV Revitalise Package (5 sessions)

1,658.00MYR

IV Revitalise Package (10 sessions)

3,141.00MYR

IV Revitalise Package (15 sessions)

4,450.00MYR

Enter coupon

Subtotal

0.00MYR

Tax

0.00MYR

Total

0.00MYR

TERMS AND CONDITIONS

1. Our team will contact you within an hour when the order is placed during working hours. Please expect delays however if the order is placed outside of working hours.

2. Please note the preferred times are subject to availability. Speedoc will try its best to allot the time selected, but due to high demand we may offer a different appointment time.

3. Available in Penang, Ipoh, Melaka, Johor Bahru, Kuala Lumpur and Klang Valley.

4. All patients are required to sign a consent form. This form will be provided to you before the treatment is conducted.

5. Not recommended for individuals who are pregnant, or with pre-existing medical conditions in relation to heart, kidney, liver. People with fluid, electrolyte or mineral restrictions.
I agree to the above Terms and Conditions
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Patient's Details