Infusion Wellness

Mock – Customer info and screening questions

    Customer Information

    • Pregnant

    • Heart Disease

    • Leber's Disease

    • High Blood Pressure

    • Chemotherapy

    • Warfarin Prescription

    • Other

    • None

    Health Goals

    • Immune Support

    • Brain Support

    • Energy Boost

    • Anti-aging

    • Mental Health

    • Weight Management

    • Recovery

    • Athletic Performance

    • >

    Contra Indicators

    Each infusion may have different contra indicators. So when a infusion is checked, the questions related to that specific infusion will appear

    Informed Consent

    E-singature

    Date

    I just plan to walk in

    Checking this box will disable the calendar/appointment function

    Make an Appointment

    Performance


    Recommended infusions to enhance performance

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    Elevate Your Life

    Stay healthy and let's get started!

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    Performance

    Recommended infusions to enhance performance
    Gluathione
    Immunity Shot