This document is confirmation of informed consent for IV therapy being provided by The IV Suite


I _______________________ have disclosed of my known allergies to any drugs, substances, vitamins, medications and any past reactions to anaesthetic drugs or procedures. I have also informed the treating medical professional of all my past and current medications and supplements.

I understand that:

a) The procedure involves inserting a needle into a vein or an intramuscular injection. The specific therapy will then be delivered by this route

b) The injection can (occasionally to commonly) cause discomfort, bruising, swelling and pain at the site. Rarely the vein can be inflamed causing phlebitis.

c) If there are allergens unknown to the client there may be mild - severe allergic reactions, anaphylaxis, cardiac arrest. In the event of an allergic reaction, I give The IV Suite consent to act accordingly and institute any emergency medical treatment/procedure required.

My signature on this form affirms that I have received all the information and explanation I desire for this procedure and I give consent to the IV therapy.
Scroll to Top