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Patient Consent Form

  • After consultation with Dr. Warren, I have decided to undergo Intravenous Multi-Vitamin Therapy. I have been advised that whether or not Intravenous Multi-Vitamin therapy is “safe” or “effective” for a specific condition depends on the degree of likelihood of injury from the use of the procedure when properly administered, upon the prognosis for the condition if left untreated, and upon cooperation in following the dietary, metabolic nutrient recommendations, and rest regime, which accompanies the procedure. It is believed in my case IV Multi-Vitamin therapy is proper under these criteria and the condition for which I am being treated and my overall health will probably improve from its use.

    I understand no one can or does guarantee results in any manner. My signature on this agreement constitutes a full and final release of the clinic’s legal responsibility for harm resulting from the administration of IV Multi-Vitamin Therapy in my case and/or any other medical treatment, which may be necessary as a result thereof.

    The FDA has not evaluated this statement. This product is not intended to diagnose, treat, cure, or prevent any disease.

    I have read and understand the above.