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Patient Assessment Form

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Thank you for choosing IVs in the Keys to provide you with our medically designed rehydration therapy. It is our goal to provide you with the best treatment available in a safe and comfortable manner. In doing so we have established a set of protocols that identify higher risk patients that may require and benefit from a higher level of medical care. Due to these protocols, and to ensure maximum patient safety, some clients may not be eligible to receive IVs in the Keys therapy. We thank you for your understanding in this matter. By signing below, you certify that you understand and agree with the following statements.

  • I have read and understand the medical disclaimer.
  • All the information I have provided in my medical screening is complete and accurate to the best of my knowledge.
  • I understand that while receiving my treatment I will not be able to leave the direct supervision of IVs in the Keys staff, including the restroom. If I need to use the restroom I will alert an IVs in the Keys team member and they will assist me.
  • I understand the risk of IV insertion may include: pain, bleeding, bruising, blood clots, infection, and local soft tissue damage. While I understand that these side effects are rare, they may occur and I understand to seek immediate medical attention if such complications arise
  • I certify that I am at least 18 years of age and have provided photo ID if asked to present it.
  • I understand that not all people react the same way to medications and treatment and that while most feel better after therapy, there is no guarantee that I will feel the same way.
  • I understand that the IVs in the Keys team has the right to refuse or terminate my treatment at any time for any reason and that I must comply with their instructions while receiving treatment.
  • I certify that I am not intoxicated or under the influence of any mind altering substances at the time of therapy.
  • I understand that IVs in the Keys Hydration Clinic, for staff and customer safety, is under constant video surveillance.
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Whether it’s recovering from a long race, a long night, or just a very needed boost, you’ll feel your IV therapy infusion begin to work immediately. Relieve headaches, get rid of nausea, and restore energy. You’ll feel like a brand new person!

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