1. Purpose
The purpose of this form is to obtain your informed consent for: Health and wellness services administered by Livelydrops and its affiliates Dr. Gupta. These services are being provided by: Livelydrops and its affiliates Dr. Gupta.
The reason these services are being provided is: General Health and Wellness and therapeutic benefit. You understand that your healthcare insurer may not consider IV Drip or IM Injections for therapeutic benefit a medically necessary service. You acknowledge and understand that your healthcare insurer may not cover services that are not medically necessary, investigational, or experimental.
2.nature of the services
The Livelydrops services consist of infusions into my body through IV drip or IM injection, of vitamins, minerals, and/or other nutrients suspended in a liquid form. A needle and or a needle and a catheter will be inserted through my skin either into a muscle or a vein in order to introduce this liquid into my body.
3. RISKS, BENEFITS AND ALTERNATIVES
The benefits of the Services potentially include: increased energy, hydration, increase in metabolism, cardiovascular support, nail, skin and hair health, and immune-system support.
The risks include: (i) injection/venipuncture site swelling, redness, irritation, bruising, bleeding, and infection, (ii) reaction to vitamins including fever, aches, nausea, rash, hives, wheezing, joint swelling, and general allergic reaction, including anaphylaxis, and extravasation and (iii) other minor complications of IV or IM injection.
4. Non-FDA EVALUATED OR APPROVED
I, as patient signing and consenting below, understand and acknowledge that the United States Food and Drug Administration has not evaluated or approved the treatments I am about to receive to diagnose, treat, cure, or prevent any disease. The FDA might in fact recommend other treatments.
5. JUDGMENT AND CHANCE TO ASK QUESTIONS
In giving the consent hereunder, I, as patient, am relying on the judgment of the clinical professional evaluating me and administering the treatments. I have had the meaningful chance to ask questions and have received satisfactory answers to my questions. The risks and potential benefits of the treatment I am consenting to have been explained to me. Alternatives to the treatments I am consenting to have also been discussed with me.
