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
*
Type of Appointment:
Please Select
IV Therapy
Injection (B-12, Lipo-B, Vitamin D) IN OFFICE ONLY
MMCC-Medical Cannabis Initial & Recert
Medically Managed Weight Loss (Belcamp office ONLY)
Aesthetics - Facials/Botox (Belcamp office ONLY)
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)
Are You A New Patient
*
Yes
No
Credit Card Required
All new clients are required to provide a credit card to secure your appointment.
Credit Card Number
*
Expiration
*
CVV (3 or 4 digit code on back)
*
Billing Zip Code
*
Appointment Location:
*
Please Select
Baltimore (Belcamp) Office
Baltimore 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
Virtual Appointment (MMCC ONLY)
If mobile, please provide service address:
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 state of Maryland and 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 the owner, 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
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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