Consent Statement:

I voluntarily consent to receive intramuscular (IM) wellness injections, IV infusions administered by licensed medical professionals with LIV Infusion & Wellness.

I understand that:

• These injections/infusions are intended for wellness support and are not a substitute for primary medical care.

• Possible side effects may include pain at injection site, redness, swelling, allergic reaction, dizziness, or infection.

• Results are not guaranteed.

• I have disclosed my full medical history to the best of my knowledge.

I acknowledge that I have had the opportunity to ask questions and all questions have been answered to my satisfaction.

I have read and agree to the above consent*

LIABILITY WAIVER

I release LIV Infusion & Wellness and its staff from any liability related to the administration of IM injections/ IV infusions, weight loss self administered treatment except in cases of gross negligence.

I agree*

HIPAA & COMMUNICATION CONSENT

I consent to receive communication via phone, text, or email

I acknowledge HIPAA privacy practices*