Patient Consent Form

Complete the consent form to acknowledge your understanding and agreement with our services and policies.

Are you interested in receiving IV InfuZEN therapy or weight loss services from InfuZEN Drips?

Are you comfortable providing your consent for InfuZEN Drips to administer IV InfuZEN therapy or weight loss services to you?

Please check any medical conditions you currently have:

Hypertension Diabetes Heart Disease Allergies

Are you aware that the services provided by InfuZEN Drips are intended for wellness purposes and are not a substitute for medical treatment or advice?

Yes No

Patient Consent Form

Complete the consent form to acknowledge your understanding and agreement with our services and policies.

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