2) Medical safety check
Tap any condition that applies. If none apply, select None of the above .
None of the above
Heart disease / arrhythmia Kidney disease Liver disease G6PD deficiency Diabetes Asthma Seizure disorder Autoimmune disease Cancer (past or current) Pregnant or breastfeeding
If you selected anything above, please add brief details
6) Consent, privacy & declaration
Please read and tick each item below before signing.
I confirm I am 18 years or older.
I consent to IV cannulation and administration of GP-prescribed nutrients.
This includes cannulation, flushing, infusion, monitoring, and removal of the cannula.
I understand this service is supportive in nature and not a treatment for disease.
If I am unwell or have concerning symptoms, I will seek GP or urgent medical review as appropriate.
I consent to my information being shared with the prescribing GP for clinical review, prescribing decisions, and documentation.
I consent to collection and use of my information for screening, care coordination, documentation, and contact by SMS, phone, or email regarding my assessment, booking, safety follow-up, and aftercare.
This is for care coordination, not marketing.
I understand fees are confirmed after GP assessment and may vary depending on prescription, clinical suitability, travel, and supplies used.
I confirm the information I have provided is accurate to the best of my knowledge.
I understand incorrect or incomplete information may affect safety and suitability.
Privacy or communication notes (optional)
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Safety note: IV therapy carries risks including bruising, infection, phlebitis, infiltration, thrombosis, and allergic reaction. Very rarely, serious complications can occur.
