For Quickest Service Please
Call (480) 908-9266
– We Are Available 24/7!
Hangover IV
HYDRATION IV
NAD IV THERAPY
Blog
Contact
Menu
Hangover IV
HYDRATION IV
NAD IV THERAPY
Blog
Contact
(480) 908-9266
Form
Last and First name
Phone number
Email
DOB
Age
Address
Emergency contact: first, last name, and phone number
Physician name and phone number
Medical History
Cancer
Seizure disorder
High BP
HIV/AIDS
Hepatitis
Diabetes
Leber’s Optic Neuropathy
Hormone Imbalance
Thyroid Imbalance
Blood Clotting Disorder
Infections/illness
None of the above
Allergies
Foods/Nuts
Aspirin
Shellfish
Lidocaine
Medications
Are you pregnant?
Yes
No
Are you breastfeeding?
Yes
No
Signature
❌
Send
Schedule an IV Therapy Appointment:
For Quickest Service Please Call Us On
(480) 908-9266
We Are Available 24/7!
Your Name*
Your Name*
Your Name*
Untitled
This form is protected by reCAPTCHA
Hangover IV
HYDRATION IV
NAD IV THERAPY
Blog
Contact
Menu
Hangover IV
HYDRATION IV
NAD IV THERAPY
Blog
Contact
(480) 908-9266
X
