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Signed in as:
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TERMS CONDITIONS OF SERVICES, PAYMENT & CONSENT FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION.
Insurance Not Accepted; Client’s Responsibility for Payment.
CLIENT UNDERSTANDS AND ACKNOWLEDGES THAT REVIVE WELLNESS THERAPIES AND ITS PERSONNEL ARE NOT PAID OR REIMBURSED FOR THE SERVICES AND HANGOVER MANAGEMENT PROGRAM OR SUPPLEMENTS, VITAMINS OR PHARMACEUTICALS OFFERED BY REVIVE WELLNESS THERAPIES BY MANAGED CARE PLANS, MEDICARE, MEDICAID, OR OTHER THIRD PARTY PAYOR PROGRAMS INCLUDING YOUR HEALTH INSURANCE CARRIER, AND DO NOT ACCEPT INSURANCE FOR SUCH SERVICES.
Clients will be BILLED DIRECTLY AT TIME OF SERVICE and shall be personally responsible for payment, regardless of whether clients are reimbursed by their insurance company, managed care plan or other third party payer.
RevIVe Wellness Therapies does NOT diagnose or treat any illness, disease or health condition. Upon entering into these Terms and Conditions, client expressly represents and warrants that they are not engaging RevIVe Wellness Therapies or its personnel with the expectation that it or they will diagnose or otherwise provide treatment for any illness, disease or condition of any nature. RevIVe Wellness Therapies personnel will not screen for, diagnose, monitor or otherwise provide any care or treatment for such conditions.
INFORMED CONSENT, CLIENT REPRESENTATIONS/WARRANTIES & DISCLAIMER AGREEMENT
Participating in intravenous (IV) hydration, vitamin/supplement administration, pharmaceutical administration, programs and services made available by RevIVe Wellness Therapies carries risks.
THE SOLE RISK OF INJURY OR HARM RESULTING IN ANY MANNER FROM CLIENTS CHOOSING TO PARTICIPATE IN SUCH REGIMEN, PROGRAMS AND SERVICES RESTS ENTIRELY WITH THE CLIENT TO THE EXTENT THAT THEY DO NOT DISCLOSE THEIR HEALTH CONDITIONS, MEDICATIONS OR DRUG USE IN ADVANCE.
Client represents and warrants to RevIVe Wellness Therapies that they have never been diagnosed with nor treated for any diseases, illnesses or conditions which may result in increased risk when they participate in regimens, programs or services made available by RevIVe Wellness Therapies, and the client is not choosing to participate with any expectation that RevIVe Wellness Therapies will screen for, diagnose, monitor or otherwise provide any care or treatment for such conditions.
Client acknowledges and understands that RevIVe Wellness Therapies is relying upon the foregoing representations and warranties from client upon RevIVe Wellness Therapies acceptance of client for participation in its IV hydration, programs and services.
Client acknowledges and understands that RevIVe Wellness Therapies is not responsible or liable for any complications that result from the use of any provided or custom requested vitamins, injections, or medication.
RISKS INCLUDE THE FOLLOWING:
INJURY, BLEEDING, INFECTION, INFLAMMATION/SWELLING, BRUISING OR SCARRING RESULTING FROM IV INFILTRATION, EXTRACTION, EXTRAVASATION AND INJECTION, MISPLACEMENT OF IV LINES IN THE BODY, AIR EMBOLISM, FLUID OVERLOAD, MEDICATION ADVERSE INTERACTIONS, NERVE INJURIES, LIGHTHEADEDNESS OR FAINTING, PAIN OR BURNING DURING INJECTION
CLIENT EXPRESSLY REPRESENTS AND WARRANTS TO REVIVE WELLNESS THERAPIES THAT THEY ARE NOT A USER OF ILLEGAL DRUGS AND/OR CONTROLLED SUBSTANCES AND ARE NOT UNDER THE INFLUENCE OF SAME OR RECOVERING FROM USE OF SAME AT THE TIME OF THE PROVISION OF SERVICES.
IN THE EVENT OF AN EMERGENCY, CALL 911 OR PROCEED TO THE NEAREST EMERGENCY ROOM.
Copyright © 2023 Revive Wellness Therapies LLC - All Rights Reserved.
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