I hereby give consent for the administration of the IV Therapy by Speedoc. IV Therapy offers the administration of a combination of vitamins, minerals and other nutrients given intravenously (directly into the bloodstream through a vein) by drip (slow administration). The IV Therapy consists of intravenous injection of a specified combination of vitamins, minerals and other known nutrients necessary for human health and healing. Although these nutrients are commonly and generally part of a balanced and healthful diet, simply replacing them cannot guarantee a cure or improvement. Your overall health is more than IV fluids, vitamins and minerals even though these will help tremendously in the promotion of a healthy functioning body. Although the nutrients used are commonly available, their being given through the intravenous drip route of administration presents certain risks which must be understood and agreed to before starting the therapy. Please read about the possible risks below:
Inability to administrate (i.e. difficulty finding or getting into a vein or the leaking of the solution out of the vein.) Redness, soreness, inflammation, discoloration, scaring or degeneration at the site of the intravenous injection or along the vein that has been used. Most often these occupancies are temporary but they can be permanent. Allergic reaction, anaphylactic reaction, shock and even death are possible with the introduction of foreign materials into the body especially through the intravenous route. If you have known allergies to any of the ingredients of the IV Therapy, please notify the nurse and doctor prior to starting the drip.You may experience certain symptoms of the rapid administration of the IV Therapy such as: lightheadedness, headache, faintness, temporary fatigue, tiredness, flushing, sweating, decreased blood pressure, drop in body temperature, difficulty breathing, diarrhea, itching, swelling locally or generally, peripheral vascular thrombosis (blood clot) at the site of injection or within the vein used.
In the event that any such rare allergic reaction does occur, the medical staff will be required to administer life saving procedures such as intravenous medications, rapid intravenous fluids, and possible cardiopulmonary resuscitation to support and stabilise the cardiovascular system and then a transfer to the nearest hospital by ambulance for observation and further management.
I understand the ingredients of the IV Therapy I am consenting to as ticked ( ) below:
I have read the above Informed Consent for the IV Therapy and fully understand that there are risks and side effects, I have no contraindications or reasons not to be on the therapy. I am aware that no cure is implied or guaranteed.
I hereby acknowledge all of the above is clear, all my questions have been asked and I have received answers that are satisfactory to me.
I acknowledge that my signature acknowledges these as facts. I hereby give my consent for the Speedoc Medical Team to perform the IV Therapy.