FORMULARIO DE CONSENTIMIENTO

Infored Consent for Treatment. I consent to all nutrient Injections rendered by the doctor(s), medical assistants or nurses employed by or associated with Modern Wellness Concierge

I understand that there are risks to vitamin nutrient Injections Including but not limited to pain, bruising, inflammation, injury, infection,

allergic reactions, headaches, dry mouth, dificulty sleeping, diarthea, blurred vision, unpleasant taste, increased urination, cramps, and metabolic disturbances. I do not expect the persons employed or associated with Modern Wellness Concierge to anticipate and or explain all risk and possible complications.

I hereby release the doctors at Modern Wellness Concierge from all liabilities regarding my treatment with vitamin/nutrient Injections. I understand that nutrient Injections may not be approved by the United States Food and Drug Administration for the treatment of my medical condition.