Consent & Telehealth Portal

A telehealth exam is required before receiving any Dripsy IV Bar service to ensure safety and eligibility. Your clearance is valid for 6 months unless a significant change occurs in your medical history.

The $35 exam fee is collected securely below. After payment, you’ll be redirected to complete your exam with a licensed provider—available 7 days a week, 8 AM–9 PM CST.

For help, call 318-625-7090 (Mon–Fri 8:30 AM–5 PM, Sat 10 AM–2 PM).

Name

First NameLast Name

Date of Birth

Date

Location of Nearest Dripsy IV Bar

Is the client 18 years or older?

Parent Guardian Name

First NameLast Name

Relationship to Minor

Parent/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Informed Consent for Services
By signing below, I consent to receive services from Dripsy IV Bar and its network of licensed medical providers, which may include:

IV therapy for hydration, vitamin, and micronutrient administration
IM (intramuscular) or Subcutaneous injections for vitamin or medication delivery
Weight management therapies, including GLP-1 medications and other prescribed compounds
Peptide therapies, which may be compounded, off-label, or for research use only under applicable consent
Microneedling and skin rejuvenation services
Laboratory specimen collection, including blood, hair, urine, and swabs for diagnostic or wellness testing

Understanding the Benefits and Risks
I understand that these treatments are elective and designed to promote wellness, hydration, improved energy, symptom relief, and overall well-being. However, individual results vary, and no outcome is guaranteed.

Potential benefits may include:

Improved hydration and electrolyte balance
Enhanced recovery, energy, and immune function
Support of metabolic and cellular health
Improved skin appearance and texture (for microneedling services)

Potential risks and side effects may include:

Pain, bruising, or bleeding at the injection or IV site
Temporary discomfort, redness, or swelling
Infection, inflammation, or allergic reaction
Dizziness, nausea, or fainting
For microneedling: redness, pinpoint bleeding, peeling, or pigmentation changes
For medications and peptides: gastrointestinal upset, fatigue, headache, or other systemic effects

I have disclosed all medical conditions, allergies, and medications truthfully. I understand that while adverse reactions are rare, they can occur, and medical attention may be required.
I release Dripsy IV Bar, its medical directors, affiliates, and staff from liability associated with known and unforeseen risks related to these services when performed as described.

Acknowledgment
I understand that I may withdraw consent at any time but that fees for services rendered are non-refundable. I confirm that all questions regarding treatment, alternatives, and risks have been answered to my satisfaction.

Minor Consent
If the client is under 18 years of age, consent from a parent or legal guardian is required before receiving any Dripsy IV Bar service.

I, the undersigned parent or legal guardian, hereby authorize Dripsy IV Bar, its licensed providers, nurses, contractors, and staff to perform evaluation and/or treatment on the minor listed below. This includes, but is not limited to, IV therapy, IM injections, weight management therapies, peptide treatments, microneedling, and laboratory specimen collection (blood, hair, urine, or swab).

I acknowledge that I have reviewed the Informed Consent for Services, understand the potential risks and benefits, and have had the opportunity to ask questions prior to treatment.

I understand and agree that:

The parent or legal guardian must be present during the required telehealth exam for the minor.
All treatments and specimen collections are elective and may be refused or discontinued at any time.
Dripsy IV Bar’s providers reserve the right to decline or postpone treatment if, in their professional judgment, it is not medically appropriate or safe.
In the event of a medical emergency, I authorize Dripsy IV Bar personnel and providers to initiate appropriate emergency care, including contacting emergency medical services (EMS), and to share relevant health information as necessary to ensure the safety and wellbeing of the minor.
This consent remains valid for all future visits and treatments until the minor reaches the age of 18, unless revoked in writing.

Signature

My Products

Telehealth Exam

Once payment is submitted, you’ll be redirected to begin your secure telehealth exam — available 7 days a week from 8 AM–9 PM CST.

$35.00

Total

Payment Methods

Debit or Credit Card