Injection Therapy Consent Form

This form discusses the administration of intramuscular and/or subcutaneous injections. If you are having injection therapy, then you understand that a vitamin, mineral, nutritional compound, and/or medication will be injected directly into the subcutaneous fat or muscle of your body. This is considered “Injection Therapy.”

Please review each point below acknowledging that:

-----Injection therapy at Natura Med Spa and IV Bar is not intended to diagnose or treat a specific medical condition.

-----Injection therapy will not prevent, treat, or cure and medical condition or disease. Furthermore, I understand that I am here seeking injection therapy voluntarily to assist with certain symptoms or ailments I may experience.

-----I have informed my provider at Natura Med Spa and IV Bar of all the medications, supplements, and allergies that I have. I understand that serious adverse events could happen if I do not disclose all my drug/food/vitamin/and additional allergies and medications/supplements that I am currently taking.

-----Injection therapy and any claims made about these treatments have not been evaluated by the US Food and Drug Administration (FDA) and are not intended to diagnose, treat, cure, or prevent any medical disease. I understand that these treatments are not FDA approved for any given indications of treatment and are not considered a medical necessity.  

-----I have been informed of the procedure involving injections, the alternative treatment options, and the risks and benefits of the mutually agreed upon treatment. 

-----I understand that the procedure involves having a solution injected into my muscle or body fat.

-----I understand that common risks involved injection therapies include, but are not limited to, irritation, pain, discomfort, bruising, and bleeding at the site of the injection.

-----I understand that less common risks involved with injection therapies include, but are not limited to, infection at the site of injection, injury to the tissue, medication interactions, and drops in blood sugar levels.

-----I understand that rare side risks involved with injection therapies include, but are not limited to, severe allergic reactions, severe medication/supplement interactions, anaphylaxis, blood clots, shock, cardiac arrest, and death. 

-----I understand that the benefits injection therapies include, but are not limited to, enhanced absorption of vitamins and minerals as they bypass the digestive tract, alleviation of certain symptoms, increased total body nutrient density, and improved performance/recovery.

-----I affirm that I am voluntarily seeking injection therapies at Natura Med Spa and IV Bar and have not been coerced into doing so.

-----I understand the risks and benefits of injection therapy and have had all my questions answered to my full satisfaction.

-----I understand that unforeseeable complications can arise when medications/fluids/minerals/vitamins are administered into the body. 

-----I understand that I have the right to refuse any treatments or treatment recommendations at any time.

Voluntary Nature of Treatment and Alternative Therapies

Treatment with injectable vitamins/nutritional/mineral and/or medications offered at Natura Med Spa and IV Bar is completely voluntary in nature. Alternative therapy for the symptoms you are seeking injectable therapy for include, not are not limited to, ongoing treatment by your primary care provider and/or specialty provider, oral supplementation, and dietary/lifestyle modifications.

I acknowledge that injection therapy provided at Natura Med Spa and IV Bar is voluntary in nature and that I am seeking out this therapy on my own or from the recommendation of my referring provider. I acknowledge that I have also notified my medical and/or mental health provider about my decision to pursue injectable vitamin/hydration/nutritional/mineral therapy. I acknowledge the alternative treatment options and have voluntarily decided to pursue injectable therapy.

Final Patient Consent For Treatment

-----I have had the nature of the procedure and/or treatment, the benefits of treatment, the risks of treatment, the side effects, the alternative therapies for my medical condition or symptoms I am seeking treatment for, and the chances of treatment success explained to me. I have had all my questions and concerns answered to my satisfaction. I acknowledge that I have been given sufficient information about injection therapy and all its associated risks and benefits upon which to make an informed decision about treatment. 

-----I acknowledge that there are no guarantees regarding the results of treatment and its effect on my presenting condition. 

-----I give my consent for the use of emergency intervention if required during treatment.

-----I certify that I am of sound mind and body to make medical decisions and to consent for treatment.

-----I certify I will continue to remain under the care a licensed and qualified primary care provider and/or mental health provider as injection therapy is considered an adjunctive and non-medically necessary treatment option, not a complete one.

-----I release my provider at Natura Med Spa and IV Bar and all the medical staff from all liabilities for any complications or damages associated with injection therapy.

-----I have read this consent and fully understand the information within it and I voluntarily authorize and consent to the treatment options, including but not limited to injection therapy provided to me at Natura Med Spa and IV Bar.

Denver HS-EF Court Place, LLC, as owner of the Sheraton Denver Downtown Hotel, By Sheraton license Operating Company, LLC as Operator of behalf of Owner, Marriott Hotel Services, Inc, Marriott International Inc., its subsidiaries, affiliates, respective employees, representatives and agents, and any other persons or entities specified by Property are to be named as Additional Insureds under the liability policies, and copies of endorsements when applicable, shall be delivered to Property prior to Vendor’s commencement of services, and from time to time, and at least twenty (20) days prior to the expiration of the term of each such policy