Before your appointment

Intake and consent

One form covers your medical history and the treatment consent our clinician needs — the same information we would take on paper, just once instead of twice.

About 4 minutes to completeSeen only by our clinical team

Your details

You are a guest on booking .

Please fill this in with your own details. When you submit, your form goes to the clinician looking after your group.

This is what we file your record against, so please use the same details you booked with.

In case of emergency

Medical history

Please tick everything that applies. If none apply, tick "None of the above".

Thank you for telling us.

G6PD deficiency means high-dose Vitamin C and our Immunity infusion are not suitable for you. Our clinician will review this with you and recommend a safe alternative before any treatment. Please bring your lab result if you have one.

What brings you in

Tick everything that applies.

Understanding your treatment

Please open and read each part — all three are required. This is the same consent you would sign on paper with our clinician.

IV therapy involves inserting a small catheter into a vein, usually in the hand or forearm, through which fluids, vitamins, minerals and other substances are delivered directly into the bloodstream, bypassing the gut for near-complete absorption. Potential benefits include faster fluid and electrolyte balance, immediate cellular uptake of nutrients, and support for recovery, immunity and energy.

Possible risks include infiltration, phlebitis, bruising, infection, air embolism, allergic reaction, fluid overload and nerve irritation. No medical procedure is risk-free; rare complications may need emergency care.

Intravenous (IV) therapy involves the insertion of a small catheter into a peripheral vein, typically in the hand or forearm, through which fluids, vitamins, minerals, electrolytes, amino acids, medications and/or other compounded substances are administered directly into the bloodstream. The procedure bypasses the gastrointestinal system, resulting in near 100% bioavailability of all administered substances. Potential benefits include rapid restoration of fluid and electrolyte balance; enhanced delivery of vitamins and minerals with immediate cellular uptake; accelerated recovery from illness, dehydration or physical exertion; support for immune function, energy production and anti-ageing protocols; and improved absorption compared with oral supplementation.

I understand that IV therapy carries the following potential risks, which have been fully explained to me. Infiltration — IV fluid leaks into surrounding tissues, causing local swelling and discomfort or pain. Phlebitis — inflammation of the vein, with redness, warmth and pain at the insertion site. Haematoma — bruising or blood pooling at the IV site following catheter insertion. Infection or sepsis — localised or systemic infection, risk reduced using an aseptic technique. Extravasation — leakage of irritating substances into tissue, potentially causing damage. Air embolism — introduction of air into the bloodstream, minimised through proper line priming. Allergic or anaphylactic reaction — severe hypersensitivity requiring emergency intervention. Fluid overload — excessive fluid administration, particularly dangerous in cardiac or renal disease. Nerve injury — inadvertent needle contact with nearby nerves, with possible neurological symptoms. I understand that no medical procedure is risk-free. Possible risks of additives can include, but are not limited to, dizziness or fainting, nausea, headache, electrolyte imbalance, medication or vitamin reactions, and other unforeseen complications. Rare complications may be serious and may require emergency medical treatment or hospitalisation.

Some substances used — including compounded vitamins, NAD+ and glutathione — are not individually approved by a drug regulator for elective IV use. Certain formulations, including high-dose Vitamin C, are contraindicated during pregnancy or breastfeeding. Oral supplementation, IM injection and standard medical care remain available alternatives. If pregnant or breastfeeding, please say so above so your provider can review your formulation.

Some substances administered during IV therapy, including compounded vitamins, minerals, amino acids, NAD+ and glutathione preparations, have not been individually approved by a drug regulator for intravenous use in elective wellness settings. I understand and accept this disclosure.

Certain formulations, including high-dose Vitamin C, chelating agents and some compounded preparations, are contraindicated during pregnancy and breastfeeding. By signing, I confirm that I am not currently pregnant or breastfeeding, or that I have disclosed my status and my supervising provider has reviewed and approved the specific formulation. I understand that alternatives include oral supplementation, intramuscular injection, dietary modification and standard medical care, and that these have been discussed with me or are available on request.

Treatment happens at your home, hotel or another agreed location, not a hospital — this is not a substitute for emergency care. If I develop severe symptoms before or during treatment, I will seek or accept emergency care, and I authorise the clinician to call emergency services if needed. No specific outcome is guaranteed. I will follow aftercare instructions, and I may stop or refuse treatment at any time; fees for services already provided may still apply.

I understand that treatment may occur at my home, hotel, office or another agreed location rather than in a hospital or emergency department, and I agree to provide a reasonably clean, safe and accessible environment for treatment. Mobile IV hydration is not a substitute for emergency care, diagnosis or ongoing treatment by my primary healthcare provider. If I experience severe symptoms before treatment — including chest pain, severe shortness of breath, loss of consciousness, signs of stroke, severe allergic reaction or another medical emergency — I should seek emergency medical care rather than use a mobile hydration service. If an emergency occurs during treatment, I authorise the treating clinician to provide appropriate emergency assistance and to contact emergency medical services when reasonably necessary. I understand that individual responses to IV hydration vary, and that no guarantee or promise has been made regarding any particular health, wellness, recovery, beauty, energy, immunity or other outcome.

I agree to follow aftercare instructions and to promptly seek medical attention if I develop concerning symptoms after treatment, and I understand that I should not rely on IV hydration to delay medically necessary evaluation or treatment. I consent to the collection and use of my health and contact information as reasonably necessary to assess, provide and document my care, arrange follow-up, process payment and meet applicable legal or regulatory obligations; separate written consent will be obtained before using identifiable photographs, testimonials or health information for marketing. I acknowledge that the nature, purpose, expected benefits, reasonable alternatives and material risks of the proposed treatment have been explained to me and that I have had an opportunity to ask questions. To the fullest extent permitted by applicable law, I accept the ordinary and inherent risks of the treatment that have been disclosed to me. Nothing in this document is intended to waive rights that cannot lawfully be waived, excuse professional negligence, or limit obligations imposed by applicable Jamaican law or professional standards. I understand that I may refuse or stop treatment at any time before or during the procedure, without penalty or prejudice to my future care, and that fees for services already provided or supplies already used may remain payable in accordance with DRIP’s disclosed cancellation and payment policies.

Privacy notice

How your information is used, and your rights over it.

We use your health and contact information only to assess, provide and record your care, arrange follow-up, take payment and meet legal obligations. We do not sell your information, and we will ask separately in writing before using any photo, testimonial or health detail for marketing.

Your rights: request a copy of your record or a correction to it; ask us to communicate confidentially or restrict certain uses; ask who it has been shared with; be told promptly of any breach; and get a printed copy of this notice on request. To exercise any of these, contact us on WhatsApp 876 230 7994 or at dripjamaica@gmail.com.

Your declaration

Sign

Type your full name below to sign. That is your signature on the consent above.

Private to you and reviewed only by our clinical team. You may withdraw consent at any time before treatment. IV therapy is not intended to diagnose, treat, cure or prevent disease.

Thank you

Your intake and consent are on file. Our clinician will review everything before your appointment — nothing further to fill in.

Your form is attached to your group’s booking, so the clinician treating you can read it before your appointment.