WELCOME
Thank you for choosing our practice. Our philosophy of practice is integrative and oriented towards finding the least harmful approach to reaching health. Our philosophy of health is to balance the internal environment (i.e. infections, toxins, and stressors). Dr. Clyde McMorris wants to work interactively with you to achieve optimal health. You, the client, are an expert in terms of knowledge of your own body while Dr. Clyde McMorris and team can help interpret signs and symptoms in terms of medical physiology. We would like to welcome you. We want you to know that we will strive to provide the best information and give you the knowledge to make informed choices about therapy and treatment.
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INFORMED CONSENT
I recognize that I will be able to ask questions and clarify any concerns with Dr. McMorris and his team prior to beginning any recommended treatment. I recognize that I am a partner in treatment decisions and will be informed of the risks and benefits of recommended treatments by Dr. McMorris and his team. After being duly informed of the risks and benefits of conventional allopathic and alternative and / or complementary treatments, I will then decide whether to proceed with alternative and / or complementary treatments. It is also my choice whether or not to proceed.
IV Hydration Therapy is a powerful way to access cells, to accelerate healing, and prevent infection. While the use of IV Nutrients is safe, in some cases there can be issues and complications. You 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 you have had the opportunity to receive such information and to give your informed consent. By following our recommendations below, we can minimize the complications and risks and ask that you follow the guidelines for IV Therapy treatment.
I understand that before starting IV Hydration Therapy, I must:
1. Notify the provider of all medications and supplements you are currently taking, and current or previous health issues you may be having;
2. Arrive to IV Therapy appointment hydrated — if dehydration occurs because of the IV nutrients, you will be given fluids to correct the hydration.
3. Arrive to IV Therapy appointment having eaten a meal or snack or bring snacks with you.
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I (the client) understand that the following will reduce the efficacy of IV Therapy and that it may take more treatments to reach optimal health:
IV HYDRATION INFORMED CONSENT
• Cigarette smoking
• Certain medications
• Caffeine consumption increases Vitamin C excretion
• Poor diet: processed foods, high sugar intake, nutrient deficient diets
• Heavy metal toxicity
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I (the client) understand that IV Therapy may stimulate the immune system.
Your signature below indicates that:
1. You have read and understand the information provided in this form, had all your questions answered, are knowledgeable about the conventional treatments available for your condition, and are aware that the IV Therapy is not FDA approved and is considered "unconventional." Long term adverse consequences of these therapies may be possible but are unknown at this time. By signing this consent, you consent to the forgoing.
2. The provider has adequately explained the IV procedure set forth to you.
3. You have received all the information and explanation you desire concerning the procedure. 4. You authorize and consent to the performance of the procedure as agreed upon with the provider.
By signing this consent, I understand these risks, and I am willing to accept the risk. I have been advised that this therapy may be beneficial in my condition. I understand the benefits of this treatment will be enhanced by engaging in positive lifestyle changes such as exercise, proper diet, and nutritional supplementation that has been recommended by the healthcare provider.
➢ I, _______________________________ give my informed consent for Intravenous Therapy, Hydrate Drip Therapy (who is trained and certified in administering, monitoring, and ordering intravenous therapies).
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I HAVE READ AND FULLY UNDERSTAND THIS CONSENT FORM AND ALL MY QUESTIONS HAVE BEEN ANSWERED, 1 understand 1 should not sign this form if Intravenous Vitamin Supplementation Therapy, it’s possible risks, and its possible benefits have not been explained to my satisfaction. I further understand that I should not sign this form if I have unanswered questions or if I do not understand anything in the consent form.
