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1. Services must be paid for at the time of service.

2. Health insurance typically does not cover services provided at Longevity IV.

3. I understand that treatments used at Longevity IV might not be considered a medical necessity. Treatments rendered are for the purpose of improving your quality of life.

4. I agree that if I am having any side effects or become sick, that I will follow up with my primary care provider or go to an urgent care or emergency department.

5. I acknowledge that Longevity IV and its healthcare providers are not my primary care provider. I agree that I will continue with routine care through my primary care provider and notify them of treatments prescribed and performed at Longevity IV.

6. I understand that there are no refunds for services or products rendered.

7. I understand that having an appointment with Longevity IV does not necessarily entitle me to having an IV infusion or injection procedure performed. Every individual is different, and it is at the medical providers discretion to issue treatment.

8. I acknowledge that I have been advised of the risks and benefits of treatment. I also acknowledge that I have been advised of possible complications and side effects. I understand the risks, benefits, complications, and side effects of treatment.

9. I am voluntarily requesting treatment with Longevity IV and its healthcare providers in regard to IV infusion therapy and injection therapy as determined by a mutual decision between myself and the medical provider even if it is not considered a medical necessity.

10. I do not hold any medical practitioner of Longevity IV responsible for performing age-related preventive care. I agree that I will follow up with my primary care provider to obtain these screenings and I hold Longevity IV and its healthcare providers harmless if an adverse event occurs during my treatment. I have read, understand, and agree to all of the above statements.