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Client Information Form

Important Message: Please Read!

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In accordance with Canadian health regulations, all new clients are required to complete this form and have their medical history reviewed and approved by a licensed medical professional before receiving an IV infusion.

Our Medical Director charges an annual fee of $85 for this review and approval. This process ensures your eligibility and safety for IV therapy and allows us to provide you with the best possible care.

Thank you for taking a few moments to complete this form — your health and safety are our top priority!

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If you have previously received an IV infusion with another provider, you may forgo this fee by providing your prior medical approval information. Please email this documentation to thrivenutritionalhealth@gmail.com prior to your appointment.

Medical History: Do you have any of the following conditions?
Are you pregnant or breastfeeding?
Birthday
Year
Month
Day
List of medications and or supplements?
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