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1. Introduction
Welcome to IV Theory. These Terms and Conditions govern your use of our website and services. By accessing or using our services, you agree to be bound by these terms. If you do not agree with any part of these terms, you must not use our services.
2. Services
IV Theory provides intravenous (IV) nutritional therapy services. Our treatments are intended to support overall health and wellness. They are not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions regarding medical conditions.
CONSENT TO MEDICAL CARE.
I hereby authorize the health care providers of IVTHEORY (“the Practice”) and their staff, to perform any medical diagnostic procedures and medical care which in their professional judgment is deemed necessary to diagnose and/or treat the conditions that have brought about my seeking medical care services from the Practice. I acknowledge that no guarantees are made to me concerning the outcomes of the treatment rendered by the health care providers of the Practice.
1. I understand that the services that Practice provides include: IV therapy, COVID-19 testing and lab testing. I agree that the Practice has communicated to me the risks and benefits associated with each treatment I am agreeing to undertake, and I have had an opportunity to ask the practitioner any questions I have on the risk associated with the treatment I am undertaking. Knowing each of those risks, I am agreeing to be proceed with services from the Practice.
2. I consent to receiving a medical screening via telehealth/telemedicine methods and understand that there are certain risks associated with receiving care through telehealth/telemedicine methods. Furthermore, I have made the medical staff aware of all my known health conditions, allergies, and medications I am taking.
3. I acknowledge the rendering of care by the staff of IVTHEORY, including the medical doctor, nurse practitioner, physician assistant, nurse, or other staff person. Care may include, but is not limited to, obtaining a medical history, performing a physical examination or telemedicine examination, and providing treatment as needed.
4. I understand that I am assuming the risk of exposure to COVID-19 (or other public health risk) by having these services provided. Moreover, by inviting the Practice into my home or workplace, I understand that there may be an increase in risk to exposure to other individuals who I am in contact with. I agree to inform the Practice if either myself or anyone I live with or anyone I have been in contact with displays any symptoms consistent with the coronavirus.
5. I understand that the Practice may create a customized therapy to meet my needs. I understand that such custom therapies may not be reviewed or approved by the Food and Drug Administration or any other entity for safety, quality, or effectiveness. I knowingly and voluntarily consent to such therapies regardless of whether they are approved by the FDA or any other entity for safety, quality, or effectiveness. 6. I hereby authorize the staff at IVTHEORY to administer either IV and/or IM therapy. I have made known to IVTHEORY’s staff of any medical history, medications, allergies, or past reactions that may interfere with therapy. This disclosure is to help me become better informed so I may make the decision to give or withhold my consent as to whether or not to undergo care having had the opportunity to discuss potential benefits, risks, and hazards involved.
Risks and Hazards: Reaction to Vitamins - Fever, rash, hives, wheezing and joint swelling are some allergic reactions you could experience during IV therapy. Bleeding, bruising, or infection of the injection or insertion site. I understand that in the practice of IV therapy that possible complications could occur, although they are very unlikely: irritation at the site of the IV insertion or the vein itself, infection, bleeding, allergic reaction to the infused vitamins, minerals or compounds including anaphylaxis, fever, nausea, upset stomach, arrhythmias, and other unlikely and possible reactions. In the event of any unforeseen severe reaction 911 will be notified. I understand that I have the right to consent to 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 IV/IM therapy. I hereby request and voluntarily consent to examination and treatment with IV therapies with vitamins, micronutrients, detoxification, nutrition, and placement of IV catheter or IM injection of Vitamins by IVTHEORY and/or other licensed independent contractors working with IVTHEORY. I have had or can request further explanation of the procedure or methods of treatment, and information about the material risk of the procedure or treatment from IVTHEORY or my own medical provider. I have had the opportunity to ask all questions and discuss with my personal healthcare provider(s) to my satisfaction, including but not limited to my suspected diagnosis or condition, the nature, purpose and potential benefit of the proposed care, the inherited risks, complications, potential hazards, or side effects of the proposed, reasonably available alternatives to the proposed treatment procedure, and the possible consequences if treatment advice is not followed. I in no way hold IVTHEORY, or its staff, or any independent contractors hired by IVTHEORY legally liable or responsible for any complications or side effects that may occur from any IV or IM therapy I receive.
FINANCIAL AGREEMENT AND GUARANTEE. I accept full and complete financial responsibility for all medical services rendered to me and agree to pay for the services in full within 7 days of receiving testing. I further acknowledge, understand, and agree that if I fail to make such payments in accordance with the payment policies of the Practice, or in the event of default of my financial obligation to pay for services rendered, the Practice may terminate the “doctor-patient” relationship with me. Furthermore, in the event of my default of my financial obligation, should my account be turned over to an external collection agency for non-payment, I agree to pay any associated collection costs. I understand that the terms herein are contractual and not a mere recital; and that I sign this document as my own free act and void of any coercion. I also understand and acknowledge that I have the right to request and receive a copy of this agreement at any time from the Company. The permissions granted herein shall begin on the date listed below and shall remain effective until terminated by the undersigned except for the financial agreement and guarantee, governing law, severability and mediation and arbitration sections herein, which cannot be terminated. My signature below verifies that I have read all the information contained in this agreement and asked questions about anything I have not understood up to this point.
3. Eligibility
To use our services, you must be at least 18 years old and capable of entering into a binding contract. By using our services, you represent and warrant that you meet these requirements.
4. Appointments and Cancellations
Appointments can be scheduled through our website or by contacting us directly. We require a minimum of 24 hours' notice for cancellations. Failure to provide adequate notice may result in a cancellation fee.
5. Payment
Payment for services is due at the time of service. We accept various forms of payment, including credit/debit cards. Prices for services are subject to change without notice.
6. Medical Disclaimer
Our IV therapy services are administered by trained professionals. However, individual results may vary, and we do not guarantee specific outcomes. You acknowledge and agree that our services are not intended to diagnose, treat, cure, or prevent any disease.
7. Limitation of Liability
To the maximum extent permitted by law, IV Theory shall not be liable for any direct, indirect, incidental, special, or consequential damages resulting from your use of our services, including but not limited to any errors or omissions in any content, or any loss or damage of any kind incurred as a result of the use of any content or service posted, transmitted, or otherwise made available via the service.
ARBITRATION AGREEMENT
Article 1: Agreement to Arbitrate: lt is understood that any dispute as to medical malpractice, that is as to whether any medical services rendered under this contract were unnecessary or unauthorized or were improperly, negligently or incompetently rendered, will be determined by submission to arbitration as provided by state and federal law, and not by a lawsuit or resort to court process except as state and federal law provides for judicial review of arbitration proceedings. Both parties to this contract, by entering into it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration.
Article 2: All Claims Must be Arbitrated: lt is also understood that any dispute that does not relate to medical malpractice, including disputes as to whether or not a dispute is subject to arbitration, will also be determined by submission to binding arbitration. lt is the intention of the parties that this agreement bind all parties as to all claims, including claims arising out of or relating to treatment or services provided by the health care provider including any heirs or past, present or future spouse(s) of the patient in relation to all claims, including loss of consortium. This agreement is also intended to bind any children of the patient whether born or unborn at the time of the occurrence giving rise to any claim. This agreement is intended to bind the patient and the health care provider and/or other licensed health care providers or preceptorship interns who now or in the future treat the patient while employed by, working or associated with or serving as a back-up for the health care provider, including those working at the health care provider's clinic or office or any other clinic or office whether signatories to this form or not.
All claims for monetary damages exceeding the jurisdictional limit of the small claims court against the health care provider, and/or the health care provider's associates, association, corporation, partnership, employees, agents and estate, must be arbitrated including, without limitation, claims for loss of consortium, wrongful death, emotional distress, injunctive relief, or punitive damages.
Article 3: Procedures and Applicable Law: A demand for arbitration must be communicated in writing to all parties. Each party shall select an arbitrator (party arbitrator) within thirty days and a third arbitrator (neutral arbitrator) shall be selected by the arbitrators appointed by the parties within thirty days thereafter. The neutral arbitrator shall then be the sole arbitrator and shall decide the arbitration. Each party to the arbitration shall pay such party's pro rata share of the expenses and fees of the neutral arbitrator, together with other expenses of the arbitration incurred or approved by the neutral arbitrator, not including counsel fees, witness fees, or other expenses incurred by a party for such party's own benefit.
Either party shall have the absolute right to bifurcate the issues of liability and damage upon written request to the neutral arbitrator.The parties consent to the intervention and joinder in this arbitration of any person or entity that would otherwise be a proper additional party in a court action, and upon such intervention and joinder, any existing court action against such additional person or entity shall be stayed pending arbitration.The parties agree that provisions of state and federal law, where applicable, establishing the right to introduce evidence of any amount payable as a benefit to the patient to the maximum extent permitted by law, limiting the right to recover non-economic losses, and the right to have a judgment for future damages conformed to periodic payments, shall apply to disputes within this Arbitration Agreement. The parties further agree that the Commercial Arbitration Rules of the American Arbitration Association shall govern any arbitration conducted pursuant to this Arbitration Agreement.
Article 4: General Provision: All claims based upon the same incident, transaction or related circumstances shall be arbitrated in one proceeding. A claim shall be waived and forever barred if (1) on the date notice thereof is received, the claim, if asserted in a civil action, would be barred by the applicable legal statute of limitations, or (2) the claimant fails to pursue the arbitration claim in accordance with the procedures prescribed herein with reasonable diligence.
Article 5: Revocation: This agreement may be revoked by written notice delivered to the health care provider within 30 days of signature and if not revoked will govern all professional services received by the patient and all other disputes between the parties.
Article 6: Retroactive Effect: lf patient intends this agreement to cover services rendered before the date it is signed (for example, emergency treatment) patient should initial here ______. Effective as of the date of first professional services.
lf any provision of this Arbitration Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this Arbitration Agreement. By my signature below, I acknowledge that I have received a copy.
NOTICE: BY USING OUR WEBSITE AND SERVICES, YOU ARE AGREEING TO HAVE ANY ISSUE OF MEDICAL MALPRACTICE DEGIDED BY NEUTRAL ARBITRATION, AND YOU ARE GIVING UP YOUR RIGHT TO AJURY OR COURT TRIAL. SEE ARTICLE 1 OF THIS CONTRACT
8. Privacy
Your use of our services is also governed by our Privacy Policy, which is incorporated into these Terms and Conditions by this reference.
9. Changes to Terms
We reserve the right to modify these Terms and Conditions at any time. Any changes will be effective immediately upon posting on our website. Your continued use of our services following the posting of changes constitutes your acceptance of such changes.
10. Governing Law
These Terms and Conditions are governed by and construed in accordance with the laws of the State of Florida, without regard to its conflict of law principles.
11. Contact Us
If you have any questions about these Terms and Conditions, please contact us at:
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