At Vitality Oslo we would like to provide the highest standards and service in IV therapy and vitamin Injection. We have policies and protocols in place to identify higher risk patients who may benefit from higher levels of medical care. Due to our measures some clients may not be able to receive our therapy. We thank you in advance for understanding the measures we take to allow for the best and safest experience.
This procedure is recommended for replacement of these essential nutrients, correction of deficiencies, and for other therapeutic effects, such as improving immune function, improving antioxidant status, reducing oxidative damage, improving fatigue, etc. We offer no diagnostic testing, we make no medical advice or diagnoses. This procedure may be considered medically unnecessary. It may or may not reduce, or cure the condition for which it has been prescribed; However, this therapy has been recommended to you in the belief that it is of potential benefit and its use will most likely improve your condition and your overall health.
The principal side effects that may accompany intravenous administration of nutrients include:
By signing below you certify that you understand and agree with the following statements.
First Name: Last Name: .
Date of Birth . Home Address .
City Post Code Mobile number: .
Emergency Contact: phone number: .
Please complete the following questionnaire to the best of your ability. All information is strictly confidential.
I, the undersigned, do hereby agree and give my consent for Athena Sundt registered nurse, and other Vitality Oslo employees under her supervision, to provide alternative medical care and treatment that I have requested in the form of intravenous or intramuscular nutrient/vitamin injections. I understand that Athena Sundt uses alternative treatment methods and I have chosen to explore this approach.
I certify that the preceding medical and personal history statements are true and correct. I am aware that it is my responsibility to inform the provider of my current medical or health conditions and to update this history. A current medical history is essential for the provider to execute appropriate treatment procedures.
Patient Signature Today’s Date: .