Immune Support Therapy Treatment

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First Name

Last Name

Phone *

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24-HOUR CANCELLATION POLICY *

Alive maintains a 24-hour cancellation policy. If notice of cancellation or rescheduling is provided to Alive at least 24 hours in advance, a full refund will be issued. If you fail to attend your appointment without prior notification, a $50 cancellation fee will be charged to your credit card.

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EMERGENCY PROCEDURES *

In the unlikely event of an emergency during your IV therapy session, our staff are trained to respond promptly and effectively. We have established emergency protocols in place, including access to emergency medical services if needed. By signing this form, you affirm your consent to IV therapy and acknowledge the potential risks. You authorize Alive to implement emergency procedures if deemed necessary, with the option to call 911 if required. If under the influence of drugs/alcohol, Alive disclaims liability for any adverse effects. You acknowledge the risks and benefits of the procedure and retain the right to withdraw consent at any time. Your signature below confirms understanding, agreement with the information provided, and authorization for treatment. You also consent to automatic blood testing in case of exposure to staff bodily fluids.

I have read and consent

TERMS & CONDITIONS *

Please carefully review these terms before using the Alive website. By utilizing this site, you agree to adhere to its terms. If you disagree, please refrain from proceeding. Users must be at least 18 years old.

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