I acknowledge that I will be receiving services from RegenOrtho Palm Beach, which may include intravenous (IV) or intramuscular (IM) administration of fluids, vitamins, and other wellness products. These services are elective and will be provided by licensed and authorized providers, employees, or contractors of RegenOrtho Palm Beach.

I understand that the nature, purpose, expected benefits, and potential risks of these services have been explained to me, and I have had the opportunity to ask questions. All of my questions have been answered to my satisfaction, and I understand that no guarantees or warranties have been made regarding the effectiveness of these services.

IV/IM therapy and booster injections are intended to support general wellness and are not intended to diagnose, treat, cure, or prevent any disease. I acknowledge that I have received or been offered a copy of the Notice of Privacy Practices (HIPAA).