IV Therapy Liability Waiver & Informed Consent Agreement

Drip Revive LLC
📍 9340 Via Azul, Pico Rivera, CA 90660, USA
📧 book@driprevive.com
📞 +1 (213) 572-6118
🌐 www.driprevive.com

This document is intended to:

• Inform you of the risks, benefits, and alternatives of IV hydration therapy
• Obtain your voluntary consent
• Protect Drip Revive LLC and its staff from legal liability

By signing this Agreement, you acknowledge that you understand and accept all terms.

Drip Revive LLC provides wellness services, including:

• Intravenous (IV) hydration therapy
• Vitamin and nutrient infusions
• Wellness injections

All services are administered by licensed healthcare professionals.

I understand that IV therapy involves certain risks, including but not limited to:

• Pain, bruising, or discomfort at injection site
• Infection
• Vein inflammation (phlebitis)
• Allergic reactions
• Fluid overload
• Dizziness or fainting
• Adverse reactions to vitamins or medications

I acknowledge that serious complications are rare but possible, including severe allergic reactions.

I understand that:

• Results vary from person to person
• No specific outcomes are guaranteed
• Services are not intended to diagnose, treat, cure, or prevent disease

I confirm that:

• I have disclosed all relevant medical conditions
• I have disclosed medications, allergies, and health history
• I will inform staff of any changes in my condition

I understand that failure to disclose accurate information may increase risks.

I voluntarily consent to receive IV therapy services from Drip Revive LLC.

I understand that:

• I may refuse or stop treatment at any time
• I have had the opportunity to ask questions

To the fullest extent permitted by law, I hereby:

• Release and hold harmless Drip Revive LLC, its owners, employees, contractors, and medical staff from any and all liability, claims, demands, damages, or causes of action arising out of or related to:
  
  • My participation in IV therapy
  • Any adverse reactions or outcomes
  • Negligence to the extent allowed by law

I agree to indemnify and hold harmless Drip Revive LLC from any claims, damages, or expenses (including legal fees) arising from:

• My failure to disclose medical information
• My misuse of services
• Any actions taken outside professional guidance

In the event of a medical emergency, I authorize Drip Revive staff to:

• Seek emergency medical treatment
• Contact emergency services

I understand that I am financially responsible for any emergency care.

☐ I consent to photos/videos being used for marketing
☐ I do NOT consent

This Agreement shall be governed by the laws of the State of California.

This document constitutes the entire agreement between the parties and supersedes any prior understanding.

By signing below, I confirm that:

• I have read and understood this Agreement
• I agree to all terms
• I voluntarily accept all risks

Client Name: __________________________

Signature: __________________________

Date: __________________________