Before your first drip

Patient intake

Fill this in once, before your visit. There is no account to create first — it takes a few minutes, and our clinician reviews it before any treatment.

This is the same information we would take on paper. Everything you enter is private and seen only by our clinical team.

Your details

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.

Privacy notice

This notice describes how your medical information may be used and disclosed, and how you can get access to it. Please review it carefully before signing.

Your rights. You may request a copy of your medical record and ask for corrections. You may request confidential communications and place restrictions on certain uses of your information. You may get a list of those with whom your health information has been shared. You may make a complaint if you believe your rights have been violated. You will be notified promptly following a breach of your unsecured health information. You may receive a paper copy of this notice on request.

How we use it. We may use or share your health information for treatment, billing and operational purposes, and as required by law. We will not sell or share your information for marketing purposes without your explicit written authorisation.

Your information is private to you and reviewed only by our clinical team. 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 them before your treatment.

One last step. Please read and sign the informed consent — it is the document our clinician needs before treating you.

It takes a couple of minutes. You can also do it when you arrive.

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