IV Therapy and the Potential Side Effects

This Informed Consent is intended to document your voluntary agreement to receive Intravenous (IV) Therapy services provided by Intellimed Wellness.

IV therapy may include, but is not limited to, administration of the following ingredients: Folic Acid, Vitamin B12, L-Taurine, Alpha-Lipoic Acid, Magnesium, B-Complex (Vita-Complex), Vitamin C (Ascorbic Acid), Zinc, Glutathione, Mineral Blends, and sterile saline solutions. The specific formulation will be selected based on your health history, treatment goals, and provider recommendation.

Intravenous therapy delivers fluids, vitamins, minerals, and other nutrients directly into the bloodstream through a sterile IV catheter. Because nutrients bypass the digestive system, IV administration may allow for more immediate systemic availability compared to oral supplementation.

IV therapy may be used to support:

Hydration
Energy levels
Immune function
Recovery from fatigue or physical exertion
Antioxidant support
Nutrient replenishment
General wellness optimization
Individual results vary, and no guarantees are made regarding specific outcomes.

Potential Risks and Side Effects

While IV therapy is generally well tolerated when administered by trained medical professionals, all medical procedures carry potential risks. Possible side effects include, but are not limited to:

Local Reactions

Pain, tenderness, bruising, or swelling at the IV site
Bleeding at the insertion site
Infiltration (fluid leaking into surrounding tissue)
Phlebitis (vein irritation or inflammation)

Systemic Reactions

Headache
Dizziness or lightheadedness
Nausea
Flushing or warmth
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Flushing or warmth
Metallic taste (common with certain nutrients)
Mild changes in blood pressure
Electrolyte imbalances
Allergic or hypersensitivity reactions (rash, itching, swelling, difficulty breathing)

Rare but Serious Risks

Infection
Fluid overload (particularly in patients with cardiac or renal conditions)
Vasovagal response (fainting)
Severe allergic reaction (anaphylaxis)
This list is not exhaustive. Unexpected reactions may occur.

Patient Responsibility

I understand that:

I must disclose my full medical history, including heart disease, kidney disease, liver disease, electrolyte disorders, pregnancy, medication use, and any known allergies.
IV therapy is not a substitute for primary medical care.
I should immediately notify clinic staff if I experience pain, burning, swelling, shortness of breath, chest discomfort, or any unusual symptoms during or after treatment.
Overuse of IV therapy or improper medical screening may increase risk of complications.
If I experience any concerning symptoms after leaving the clinic, I will seek medical attention immediately and notify Intellimed Health Inc and Intellimed Wellness.

By signing below, I acknowledge that:

I have read and understand the information provided.
I have had the opportunity to ask questions.
I understand the potential risks and benefits.
I voluntarily consent to receive IV Therapy as deemed appropriate by my provider.

Do you understand the purpose of IV Therapy and potential benefits of them? *

Yes

Are you aware of the potential side effects and risks associated with IV Therapy? *

Yes

Do you understand that you should immediately contact a healthcare professional or Intellimed Wellness if you experience any adverse effects? *

Yes

Are you willing to undergo IV Therapy under the understanding that it may cause side effects? *

Yes

Are you aware that while IV Therapy are generally safe, they do not guarantee improved health and may not work as effectively in some individuals as others? *

Yes

Do you consent to IV Therapy being administered to you by Intellimed Wellness? *

Yes

Are There Any Other Health Complications that Intellimed Welllness Should Be Aware of?

Patient Signature *

Clear

Accuracy of Information *

I certify that the above medical information is correct to my knowledge.

Privacy and Sharing of Information

I authorize the clinic and its associated health professionals to collect my personal and medical information as documented above. In addition, I authorize the clinic and its associated health professionals to communicate with my family doctor and/or referring doctor as deemed necessary for my beneficial treatment. I also understand that my personal and medical information is confidential and will only be disclosed to third parties with my permission. *

I agree

Cancellation policy

Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the physician or nurse practitioner’s day that could have been filled by another patient. As such, we require 3 hours notice for any cancellations or changes to your appointment. Patients who provide less than 3 hours notice, or miss their appointment, will be charged a cancellation fee to the card on file. *

I am aware of the Cancellation Policy.

SMS Consent

I agree to receive promotional and appointment-related text messages from Intellimed Wellness. Message frequency varies. Reply STOP to unsubscribe.

I agree

I disagree

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