Submit Your Appointment Request Today
Thank you for choosing East Coast IV, Maryland's premier IV hydration provider! Please use the following form to request your appointment and a scheduling coordinator will confirm your appointment shortly. If you have any other questions about scheduling, you can call or text (443) 252-8005.
Name
*
First Name
Last Name
Email
*
Phone Number
*
Are You A New Client
*
Yes
No
Type of Appointment:
*
Please Select
IV Therapy
Medically Managed Weight Loss (Semaglutide injections)
Injections (B-12, Lipo-B, Vitamin D) IN OFFICE ONLY
MMCC-Medical Cannabis Initial & Recert
Please choose your IV therapy:
*
Please Select
Super Immune Stimulus ($225.00)
Hangover Miracle ($165.00)
Myers Cocktail ($170.00)
High Energy Booster ($195.00)
Migraine Relief ($165.00)
Beauty Treatment ($185.00)
Performance and Recovery Booster ($175.00)
Custom IV therapy (Price varies based on additions)
NAD+ Infusion (Price varies based on dosage)
Unsure
Appointment Location:
*
Please Select
Baltimore (Belcamp) Office
Harford/Baltimore/Cecil/Howard Co. Mobile ($40 travel fee for one person)
Ocean City Office
Ocean City Mobile ($40 travel fee for one person)
Columbia Office (Wednesday and Fridays from 11am to 5pm)
Appointment Locations:
*
Please Select
Belcamp Office
Ocean City
Virtual Appointment (Initial weight loss consults)
New client deposit
*
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New client deposit
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
If mobile, please provide service address:
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Street Address
Apt, Condo or Room Number (If applicable)
City
State
Zip Code
I understand that by choosing to have an East Coast IV healthcare provider respond to my location, that I will be charged a $40 travel fee if only one person is receiving IV therapy services. I have also verified that the address East Coast IV is responding to, is within the travel area set by East Coast IV, LLC.
*
Yes
I have read and understand the cancellation policy set forth by East Coast IV LLC. "For ALL appointments we require a 24-hour notice for cancellations, unless the appointment was made same day, then we require a minimum of 2 hours prior notice to cancel your appointment without being assessed a cancellation fee. Appointments that are cancel without appropriate notice, and no shows will be subjected to a non-refundable $50.00 cancellation fee. Cancelation fees will be charged to the credit card on file. In the event of a true emergency, and at the discretion of management, the $50.00 cancellation fee can be applied as a deposit towards future services rendered within ten (10) days. We Value and respect our clients & practitioners' time and appreciate your understanding."
*
Yes
How did you hear about East Coast IV?
Please Select
Google
Facebook
Family or Friend
Referral from healthcare provider
Other
Are you experiencing symptoms of COVID 19 or flu like symptoms?
*
Yes
No
Please include desired date/time and any additional pertinent information.
*
Submit
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