Purpose of IV Vitamin C Therapy
Intravenous (IV) Vitamin C Therapy involves the administration of high-dose Vitamin C directly into the bloodstream. This method bypasses the digestive system and allows for higher concentrations of Vitamin C to be delivered to the body than is possible via oral supplementation.
G6PD Blood Test Requirement
Vitamin C Only
Please note that IV Vitamin C requires a blood test called G6PD (Glucose-6-Phosphate Dehydrogenase).
- You must have this test prior to treatment.
- The result must be within normal range to proceed.
- You must provide a copy of your test result to your practitioner.
- By signing this form, you confirm that:
- You have undergone a G6PD test.
- Your results are within normal limits.
- You understand and accept the importance of this test and the potential risks without it.
Potential Benefits
- Immune system support
- Antioxidant effects and cellular protection
- Possible enhancement in energy and recovery
- May assist in reduction of oxidative stress and inflammation
Possible Risks and Side Effects
- Discomfort, bruising, or bleeding at the injection site
- Infection at the injection site
- Dizziness or fainting
- Vein inflammation (phlebitis)
- Allergic reaction
- Hemolytic anemia (especially if G6PD deficiency is undetected)
- Electrolyte imbalances
Medical Disclosure
To ensure your safety, please disclose:
- All medications, supplements, and herbal remedies you are currently taking
- Any known allergies (especially to vitamins, preservatives, or infusion-related materials)
- Any history of kidney disease, heart disease, or other chronic conditions
- Whether you are pregnant, planning to become pregnant, or breastfeeding
Patient Acknowledgment
I understand the purpose and nature of IV Vitamin C Therapy. I have been informed of the risks, benefits, and alternatives and have had the opportunity to ask questions.
I confirm the following:
- I have completed a G6PD blood test and my result is within the normal range.
- I understand that without this result, treatment cannot proceed.
- I accept the risks and benefits associated with high-dose IV Vitamin C.
- I provide informed consent to undergo this treatment voluntarily.
