Informed Consent Form for Intravenous Therapy and Vitamin Shot
I, the undersigned, hereby authorize the Naturopathic Doctors and nurses and Shine Natural Medicine to administer intravenous therapy and or Vitamin Injection shot. I have recounted a complete history of all known health conditions and allergies that I may have. I understand that this treatment involves inserting a needle and injecting a standardized formula into my veins or muscles. I realize that there may be some discomfort at the site of treatment and that it is my responsibility to inform the attending doctor of any burning, pain or negative reactions that I may be experiencing. During intravenous treatment it is possible for the injection fluid to leak out of the vein into the surrounding tissue. I understand that although the infiltrated fluid may cause pain, it is not dangerous to my health and my body will absorb the fluid. I realize that during and after my treatment I may experience temporary discomfort at the site of treatment.
I understand that there is no implied or stated guarantee of success or effectiveness of any specific treatment. I understand that I am free to withdraw my consent and to discontinue participation in these treatments at any time.