Complete Your Intake and Consent Below

Terms Conditions & Consent

I hereby give my informed consent for the intravenous administration, vitamin therapy, vitals, basic health risk assessments (prior to any service), and/or other related health services (collectively referred to as “IV therapy”) as set forth herein.

I understand that this document is intended to serve as confirmation of informed consent for IV Therapy as ordered by a licensed healthcare provider and facilitated by Hangover Healthcare, LLC.

· I acknowledge that I have completed the medical questionnaire, the Informed Consent, and that all information is/was answered truthfully, honestly, accurately and to the best of my knowledge.

· I have stated all medications prescribed to me and any recreational drugs or over the counter medicines that I have taken in the last 72 hours on the Patient Registration form.

· I acknowledge that if the medical professional believes that I am under the influence or impaired by alcohol and/or illegal drugs, it is the medical professional’s sole discretion to deny me the services requested.

· I have read and agree to the Cancellation Policy Below.

Medical history and personal information divulged during my assessment and IV Therapy will be kept strictly confidential unless I consent to sharing my information by way of a signed release. I understand that I have the right to be informed during the procedure about the risks and benefits, except in emergencies. Procedures are not performed until I have had the opportunity to receive such information and have given my informed consent by executing this document.

The IV Therapy procedure involves inserting a needle and placing a catheter into your vein with the purpose of infusing, over a determined period of time, prescribed nutrients (normal saline with possible additive vitamins, minerals and amino acids). I understand that risks, benefits and alternatives to IV’s may include but are not limited to:

1. The risks and potential side effects:

a. Discomfort, bruising and pain at the site of injection

b. Inflammation of the vein used for injection, phlebitis, metabolic disturbances and injury.

c. Severe reaction, anaphylaxis, cardiac arrest or death

2. The benefits:

a. Injectables are not affected by stomach or intestinal disease.

b. Total amount of infusions enters the bloodstream and is available to the tissues.

c. Intravenous hydration allows for an increased absorption of vitamins that cannot always be achieved by oral supplementation. IV therapy avoids the vitamin being broken down in the stomach, which can help avoid irritation to the gastro intestinal tract.

3. Alternatives to IV vitamin therapy are oral supplementation and/or dietary and lifestyle changes.

I understand that IV Therapy is not a substitute for medicine, medical treatment, or the diagnosis, treatment, or cause of disease by a medical provider.

I am aware that other unforeseeable complications could occur. I understand that the Registered Nurse or Advanced Emergency Medical Technician performing the procedure may have to exercise their best judgement during my IV therapy if such complications occur. I understand the risks and benefits of the IV Therapy and was provided the opportunity to have all my questions answered.

I understand I have the right to consent to or refuse any proposed treatment at any time prior to its performance, subject to the cancellation policy below. With that said, I affirm that I have given my consent for IV therapy with any different or further procedures, which in the opinion of my provider(s) or other(s) associated with this practice, may be indicated.

Cancellation Policy:


If your appointment is not canceled within five (5) minutes of ordering services, you will be charged in accordance with the below:

· If you cancel after 5 minutes, but 24 hours prior to your scheduled appointment, you will be charged a $25 service fee.

- If booking for a single IV there is an additional non-refundable $25 fee.

- If you cancel anytime within 24 hours of your appointment for any reasons, you will lose your deposit.

· If you cancel, refuse to consent, and/or refuse the services once the technician has arrived or anytime thereafter, you will be charged a $50 service fee.

· If the technician arrives for your scheduled service and you are not physically present at the location where the services are to take place, you will be charged a $50 service fee.

· If the technician, in their sole discretion, believes that you are impaired by and/or are under the influence of alcohol and/or illegal drugs, and the technician denies you services, you will be charged a $50 service fee.

I agree to hold Hangover Healthcare, LLC harmless for claims or damages in connection with IV Therapy, I understand that this is a release of potential liability. I understand the information provided on this form and agree to the foregoing, I understand that there is no implied or stated guarantee of success or effectiveness of any treatment. The procedures set forth above have been adequately explained to me by the technician. I understand that I am free to withdraw my consent and to discontinue.



Clear
I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Why Choose Us

Expert Nurses for Your Care, Easy Online Appointments, Trusted Nashville Healthcare

  • Licensed Nurses: Each person on our staff is a licensed registered nurse so you know that you’re in the best hands possible.

  • Online Booking: We make it as simple as possible to book your session without having to go into an office and fill out cumbersome paperwork.

  • Community: We love the Nashville community and are trusted in the area as honest and dependable healthcare providers.

We Come To You!

We don’t charge additional travel fees!

  • Convenient Service: No need to add to your discomfort. We bring our services directly to your location, accommodating parties of two or more.

  • Mobile Availability: We operate within a 15-mile radius of downtown Nashville, ensuring accessibility for those who can't reach the clinic.

  • Effortless Booking: Once your session time is reserved, your only task is to unwind and relax while we make our way to you promptly.

  • Transparent Pricing: Our pricing is transparent and straightforward, ensuring you won't face unexpected travel fees or extra costs.

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katrina@hangoverhealthcare.com

(615) 703-5693

915 Harpeth Valley, Pl, Nashville, TN

Email: katrina@hangoverhealthcare.com

Phone: (615) 703-5693

Location: 915 Harpeth Valley, Pl, Nashville, TN

© 2024 HangoverHealthcare -

All Rights Reserved


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