NAD+ Infusion Consent Form

IV Therapy / NAD+ Infusion Consent Form

Patient & Provider Information

Introduction / Purpose

IV Therapy and NAD+ Infusion are designed to:

  • Replenish essential nutrients, vitamins, and electrolytes

  • Support cellular energy, detoxification, and recovery

  • Enhance immune function and cognitive performance

  • Promote overall wellness and longevity

Treatment Overview / How It Works

  • IV therapy involves the intravenous administration of fluids containing vitamins, minerals, antioxidants, or NAD+

  • Typical session duration: 30–90 minutes

  • Frequency determined by provider based on health status, goals, and treatment plan

Contraindications & Warnings

IV Therapy may not be suitable for patients with:

  • Severe cardiovascular conditions

  • Kidney or liver dysfunction

  • Blood clotting disorders

  • Active infections at the injection site

Precautions:

  • Patients should inform staff of allergies, medications, or prior adverse reactions to IV therapy

  • Hydration and baseline labs may be recommended

Possible Risks / Side Effects

  • Mild: Bruising, redness, or tenderness at injection site; lightheadedness; mild nausea

  • Rare: Infection, vein irritation, phlebitis, allergic reaction

  • NAD+ infusion: Temporary flushing, headache, or mild fatigue

Pre-Treatment Instructions

  • Eat a light meal before treatment unless advised otherwise

  • Hydrate adequately prior to session

  • Avoid alcohol or recreational substances before infusion

  • Inform provider of any medications, supplements, or medical conditions

During Treatment

  • Patient is seated or lying comfortably

  • IV site monitored continuously for any adverse reactions

  • Vital signs may be checked before, during, and after infusion

Post-Treatment / Aftercare

  • Continue hydration after session

  • Monitor for delayed side effects (nausea, dizziness, allergic reaction)

  • Contact provider if symptoms persist or worsen

  • Resume normal daily activities unless instructed otherwise

Patient Responsibilities

  • Provide accurate medical history and disclose all medications and supplements

  • Follow pre- and post-treatment instructions

  • Report any adverse reactions or concerns promptly

Acknowledgment & Consent

  • I understand the purpose, risks, benefits, and alternatives of IV Therapy / NAD+ Infusion

  • I voluntarily consent to undergo IV Therapy / NAD+ Infusion at AI Wellness Center of Excellence

  • I acknowledge that results may vary and no guarantees are made regarding outcomes

  • I release AI Wellness Center of Excellence, its providers, staff, and affiliates from liability, except in cases of gross negligence or willful misconduct

I consent to photographs, recordings, or data capture for medical documentation, education, or research if applicable