IV Therapy; Informed Consent

Please review the following consent form carefully, which outlines the procedure, associated risks, and potential side effects. If you agree with all the information provided, kindly sign the consent form to proceed with your appointment.

Intravenous Infusions provide an effective and efficient means of delivering medications, offering advantages in terms of absorption, bioavailability, dosing precision, and therapeutic outcomes. However, it's essential to follow proper administration techniques and safety protocols to ensure optimal results and minimize the risk of complications.

I understand that:

This procedure involves the administration of fluids, medications, or nutrients directly into my bloodstream through a vein using an IV catheter. Purpose of IV Infusion: The purpose of the IV infusion is to [Insert Purpose, e.g., replenish hydration, administer medication, deliver nutrients] as prescribed by my healthcare provider. The infusion may contain [Insert Components, e.g., saline solution, vitamins, medications] based on my specific healthcare needs. Procedure Description: During the IV infusion procedure:

• A healthcare professional will insert an IV catheter into a vein, typically in the arm or hand, using sterile technique.

• The IV catheter will be connected to IV tubing, which delivers the prescribed fluids or medications from an infusion bag or bottle.

• The infusion rate will be controlled to ensure the safe and effective administration of the IV solution.

• Throughout the procedure, vital signs may be monitored to assess my response to the infusion.

Risks and Side Effects: While IV infusion therapy is generally safe, there are potential risks and side effects, including but not limited to:

1. Infection at the insertion site;  Although rare, there is a risk of infection at the canula site. Signs of infection may include redness, warmth, swelling, pain, or pus at the injection site.

2. Bleeding, bruising, or swelling at the insertion site;  It's common to experience some level of discomfort, pain, or bruising at the site of the canula. This is usually temporary and resolves on its own.

3. Allergic reaction to the IV solution or medications administered; Rarely, individuals may experience allergic reactions to the medication or components of the IV therapy, such as the needle, syringe, or preservatives in the medication. Symptoms of an allergic reaction may include rash, itching, hives, difficulty breathing, or swelling of the face, lips, tongue, or throat. Anaphylaxis, a severe allergic reaction, is a medical emergency and requires immediate treatment.

4. Phlebitis (inflammation of the vein) In some cases, the tissue may become inflamed at the canula site. This can cause redness, swelling, and increased warmth in the area. It typically resolves without intervention but may require medical attention if severe

5. Fluid overload or electrolyte imbalance

6. Air embolism (rare but serious complication if air enters the bloodstream)

7. Adverse reactions specific to certain medications or components of the IV solution

Intravenous (IV) infusion therapy offers several benefits, including:

1. Rapid Absorption: IV infusion delivers fluids, medications, or nutrients directly into the bloodstream, allowing for rapid absorption and immediate therapeutic effects.

2. Hydration: IV fluids can quickly replenish hydration levels in cases of dehydration due to illness, exercise, or insufficient fluid intake.

3. Nutrient Delivery: IV infusion can deliver essential nutrients, vitamins, and minerals directly into the bloodstream, bypassing the digestive system for enhanced absorption. This is particularly beneficial for individuals with malabsorption issues or those needing higher doses of specific nutrients.

4. Medication Administration: IV infusion allows for precise administration of medications, ensuring accurate dosing and rapid onset of action. This is advantageous in acute medical conditions where prompt treatment is essential.

5. Symptom Relief: IV infusion therapy can provide immediate relief from symptoms such as pain, nausea, and inflammation by delivering medications directly to the affected areas.

6. Improved Wellness and Performance: IV infusion with vitamins, minerals, and antioxidants can support overall health and well-being, boost energy levels, enhance immune function, and improve athletic performance.

7. Customized Treatment: IV infusion therapy can be tailored to meet individual patient needs, with specific solutions formulated based on medical history, nutritional status, and treatment goals.

8. Convenience: IV infusion therapy can be administered in various settings, including clinics, hospitals, and even at home, offering flexibility and convenience for patients who require ongoing treatment.

Informed Consent for Intravenous Therapy Services hereby acknowledge that I have been fully informed of the risks, benefits, and consequences associated with participating in the intramuscular injection administration services provided by TWG International. By signing this document, I affirm that I understand and accept the following:

1. Disclosure of Medical History and Medications: I have truthfully answered all questions regarding my medical history and have disclosed any and all prescription medications, over-the-counter drugs, as well as any street or recreational drugs to the practitioner. I understand that failure to disclose relevant medical information may lead to serious complications.

2. Assumption of Responsibility: I acknowledge that I am responsible for any medical care that may be required, whether directly or indirectly related to the services provided by TWG International. If I seek medical treatment for any side effects or reactions, I understand that it will be at my own expense. I agree that the sole risk of injury or harm resulting from my participation in TWG International services rests entirely with me if I fail to disclose any health conditions, medications, or drug use in advance.

3. Representation and Warranty: I expressly represent and warrant to TWG International that I have never been diagnosed with or treated for any illnesses or conditions that may result in increased risk when participating in the services provided. I understand that TWG International does not bear responsibility for screening, diagnosing, monitoring, or providing care for such conditions.

4. Acknowledgement of Treatment Nature and Risks: I acknowledge that I have been given the opportunity to discuss the nature and purpose of the treatment, as well as the risks, complications, and consequences associated with the procedures. I understand that it is impossible to foresee or predict all possible risks and complications, and I do not expect the practitioner to anticipate or explain all associated risks.

5. Waiver of Claims: I hereby waive any and all claims related to the services provided by TWG International and agree to hold TWG International harmless regarding any complications or consequences I may experience during or following the service.

6. Confirmation of Informed Consent: I understand that this document serves as confirmation of my informed consent for Intramuscular injection as ordered by the practitioner. I have been informed of any known allergies to drugs or other substances, as well as any past reactions to anesthetics. I have also disclosed all current medications and supplements.

I am aware that other unforeseeable complications could occur. I do not expect the practitioner to anticipate and/ or explain all risk and possible complications. I rely on the practitioner to exercise judgment during my procedure. I understand the risks and benefits of the procedure, and have had the opportunity to have all my questions answered. I understand that I have the right to consent or refuse any proposed treatment at any time prior to its performance.

My signature on this form affirms that I have given my consent to Intramuscular Injection with any different or further procedures which, in the opinion of my practitioner or others associated with this practice, may be indicated. My signature below constitutes my acknowledgement that:1. I have read, understood and fully agree to the foregoing and I have received and read the pre and post care treatment information document.2. I give consent to the proposed treatment process that has been satisfactorily explained to me and I have all the information that I desire.3. I hereby give my consent and authorisation voluntarily and release TWG International of any claims that I have or may have in the future in connection with the described treatment.

GDPR & DATA PROTECTION:

I understand that my information will be kept strictly confidential and will not be shared with anyone but with TWG International. By signing below I am agreeing to information being shared with TWG International. My signature on this form affirms that I have given my consent to IV therapy with any different or further procedures which, in the opinion of my physician(s) or other associated with this practice, may be indicated.

My signature below constitutes my acknowledgement that:

(1) I have read, understood and fully agree to the foregoing and I have received and read the pre and post care treatment information document.

(2) Give consent to the proposed treatment process that has been satisfactorily explained to me and I have all the information that I desire.

(3) I hereby give my consent and authorisation voluntarily and release the establishment and its agents of any claims that I have or may have in the future in connection with the described treatment.

I have answered these questions to the best of my understanding *