IV Therapy Liability Waiver & Informed Consent Agreement

Effective Date: April 6, 2026


1. Company Information

Drip Revive LLC
📍 9340 Via Azul, Pico Rivera, CA 90660, USA
📧 book@driprevive.com
📞 +1 (213) 572-6118
🌐 www.driprevive.com


2. Purpose of This Agreement

This document is intended to:

  • Inform you of the risks, benefits, and alternatives of IV hydration therapy
  • Obtain your voluntary consent
  • Protect Drip Revive LLC and its staff from legal liability

By signing this Agreement, you acknowledge that you understand and accept all terms.


3. Description of Services

Drip Revive LLC provides wellness services, including:

  • Intravenous (IV) hydration therapy
  • Vitamin and nutrient infusions
  • Wellness injections

All services are administered by licensed healthcare professionals.


4. Acknowledgment of Risks

I understand that IV therapy involves certain risks, including but not limited to:

  • Pain, bruising, or discomfort at injection site
  • Infection
  • Vein inflammation (phlebitis)
  • Allergic reactions
  • Fluid overload
  • Dizziness or fainting
  • Adverse reactions to vitamins or medications

I acknowledge that serious complications are rare but possible, including severe allergic reactions.


5. No Guarantee of Results

I understand that:

  • Results vary from person to person
  • No specific outcomes are guaranteed
  • Services are not intended to diagnose, treat, cure, or prevent disease

6. Medical Disclosure

I confirm that:

  • I have disclosed all relevant medical conditions
  • I have disclosed medications, allergies, and health history
  • I will inform staff of any changes in my condition

I understand that failure to disclose accurate information may increase risks.


7. Voluntary Consent

I voluntarily consent to receive IV therapy services from Drip Revive LLC.

I understand that:

  • I may refuse or stop treatment at any time
  • I have had the opportunity to ask questions

8. Release of Liability

To the fullest extent permitted by law, I hereby:

  • Release and hold harmless Drip Revive LLC, its owners, employees, contractors, and medical staff from any and all liability, claims, demands, damages, or causes of action arising out of or related to:
    • My participation in IV therapy
    • Any adverse reactions or outcomes
    • Negligence to the extent allowed by law

9. Indemnification

I agree to indemnify and hold harmless Drip Revive LLC from any claims, damages, or expenses (including legal fees) arising from:

  • My failure to disclose medical information
  • My misuse of services
  • Any actions taken outside professional guidance

10. Emergency Care Consent

In the event of a medical emergency, I authorize Drip Revive staff to:

  • Seek emergency medical treatment
  • Contact emergency services

I understand that I am financially responsible for any emergency care.


11. Photography & Marketing Consent (Optional)

☐ I consent to photos/videos being used for marketing
☐ I do NOT consent


12. Governing Law

This Agreement shall be governed by the laws of the State of California.


13. Entire Agreement

This document constitutes the entire agreement between the parties and supersedes any prior understanding.


Acknowledgment & Signature

By signing below, I confirm that:

  • I have read and understood this Agreement
  • I agree to all terms
  • I voluntarily accept all risks

 

Client Name: __________________________

Signature: __________________________

Date: __________________________

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