By completing this Client Profile, you will assist us in evaluating you and your specific concerns. The information you will provide will be used to determine what factors may be affecting you so that we may recommend the proper treatment care.

Lifestyle

Please indicate the frequency of these foods consumed on a weekly basis:

Please indicate the quantities of fluid consumed daily

Please check any health conditions which you have ever had previously or are now experiencing

Allergies: Type of reaction

If you answered ("Yes") to any of the above questions, it may be advised by your practitioner that you not receive IV Fluids, and you may be denied services.

IV VITAMIN HYDRATION RISKS INCLUDE THE FOLLOWING:

Injury Bleeding Infection Inflammation/Swelling Bruising or scarring from IV infiltration Extraction Extravasation of fluid Misplacement of IV lines in the body Air Embolism Fluid overload Adverse interactions with medications Nerve injury Light headedness or fainting! acknowledge that I have been given the opportunity to discuss the nature and purpose of the treatment and the risks, complications, and consequences associated with the procedures.

I Am aware that it is impossible to foresee or predict all possible risks, complications, and consequences, and I do not expect that the staff to anticipate or explain all associated risks. I waive any and all claims related to the services provided and agree to hold the VinDoc Lab IV practitioner harmless regarding any complications or consequences I experience during or following the service.

This document is intended to serve as confirmation of informed consent for IV therapy as ordered by the practitioner. I have informed the physician of any known allergies to drugs or other substances, or of any past reactions to anaesthetics. I have informed the practitioner of all current medications and supplements. I understand that I have the right to be informed of the procedure, any feasible alternative options, and the risks and benefits. Except in emergencies, procedures are not performed until I have had an opportunity to receive such information and to give my informed consent.

I understand that participating in the intravenous (IV) hydration and vitamin administration services provided by my Practitioner carries risks.

I have truthfully answered all questions regarding my medical history and have informed the staff about any and all prescription medications and/or over the counter drugs I take, as well as any street or recreational drugs.

I understand that failing to inform the staff about my medical issues and/or drug use can lead to serious complications.

I acknowledge that I am responsible for any medical care I may have and not discussed, any side effect or reaction, it will be at my own expense. I acknowledge and agree that the sole risk of injury or harm resulting in any manner from my voluntary participation in LITTLE BEAUTY ACADEMY TRAINING services rests entirely with me to the extent that I fail to disclose my health condition(s), medications, or drug use in advance of the services provided. ******There is no guarantee that hydration therapy will temporarily or permanently cure or resolve your hangover, effects of altitude sickness, dehydration, or viral, illness. Please drink alcohol in moderation. Heavy drinking after hydration therapy can lead to stomach irritation or other complications. Hydration therapy is not a cure for heavy drinking. Excessive drinking can lead to alcohol poisoning and other serious medical problems. Always drink alcohol in moderation.

I understand that:

1. The procedure involves inserting a needle into a vein and injecting the prescribed solution.

2. Alternatives to intravenous therapy are oral supplementation and/or dietary and lifestyle changes.

3.Risks of intravenous therapy include but not limited to:

a. Occasionally to commonly: Discomfort, bruising and pain at the site of injection.

b. Rarely: Inflammation of the vein used for injection, phlebitis, metabolic disturbances, and injury.

c. Extremely Rarely: Severe allergic reaction, anaphylaxis, infection, cardiac arrest and death.

d. Benefits of intravenous therapy include. Injectables are not affected by stomach, or intestinal absorption problems. Total amount of infusion is available to the tissues. Nutrients are forced into cells by means of a high concentration gradient. Higher doses of nutrients can be given than possible by mouth without intestinal irritation.

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 physician(s) to exercise judgment during treatment with regards to 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 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 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.