Sherman Oaks, CA
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This document is intended to serve as informed consent for your Intravenous (IV) Nutrient Therapy as ordered by Sayana Medical.
My signature below confirms that:
1- I understand the information provided on this form and agree to all statements made above.
2- Intravenous (IV) Nutrient Therapy has been adequately explained to me by Sayana Medical.
3- I have received all the information and explanation I desire concerning the procedure.
4- I authorize and consent to the performance of Intravenous (IV) Nutrient Therapy.
IV Nutrient Therapy Consent Form will be submitted to Sayana Medical Spa and Wellness Center