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Attention!

In order for us to administer an intravenous solution to you, we must require you to fill out our Medical Intake Survey, if you haven't already. The questionnaire will be submitted to our Medical Director for review, who will ultimately determine whether you are eligible to receive IV infusions based on the answers you provide. This only needs to be completed prior to your first IV, once filled out you won’t need to fill it out again. However if you fail to complete this survey, we will be unable to administer your IV infusion.