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Terms and Conditions

I have been
informed and understand that:

1. Intramuscular injections or intravenous vitamins are intended to promote health but may have side effects. While chances of experiencing complications are small, it is the practice of our clinic to inform patients about them. These complications may occur at the injection site and include, but are not limited to soreness in injection area, lumps, nodules, welts, blisters, discoloration, shooting pain in injection area, and or burning pain which may last up to 3 months post treatment including but not limited to discomfort, dull pain, mild swelling, bruising, dizziness, or temporary worsening of existing symptoms.
2. More serious complications are extremely rare but if you experience rash, shortness of breath, swelling in mouth, lips or face occur directly after injection, report to emergency care as soon as possible or call 911. Additional information on side effects and complications is available upon request.
3. Intramuscular injections will be administered in one of two locations depending on your preference: deltoid muscle of right or left arm, or in dorso-gluteal muscle on right or left hip. Vitamin C injections will always be administered in the subcutaneous fat, usually in the abdomen area.
4. For the purposes of an IV the vein in your arm will be punctured to allow the drip to occur. Sometimes due to complications with veins, multiple punctures may need to happen to successfully access the vein. If you know of any past experiences where an IV you received failed or was difficult to administer, please disclose this to your nurse prior to treatment start so they may be best prepared for an ideal outcome and so they may take proper precautions.
5. The puncture site of an IV or injection may bruise and leave pain for one to two weeks post treatment.
6. Please do not move your arm once the IV has started.
7. Do not bend your arm that has an IV attached otherwise the IV may become blocked and fail to administer.
8. When the IV has finished, blood may draw back into the tube due to natural pressure/flow. Do not become alarmed, you may raise your arm slightly to stop this.
9. Your healthcare provider will review the procedure with you prior to injection. Please ask questions where they may arise. If you have any past experiences with needle phobia, fainting or heightened pain response, please notify practitioner prior to injection so they may take proper precautions. If your physician or nurse does not explain the procedure, its benefits, and risks to your satisfaction, please ask for more information.
10. Methylcobalamin, Hydroxycobalamin, or Cyanocobalamin will be used for B12 injections. Typically, those who receive B12 injections experience more energy which may cause difficulty sleeping at night if taken late in the day. If receiving B12 injection or intravenous therapy, it is recommended to have eaten prior to treatment, for B12 has the potential to cause nausea if administered on an empty stomach. Urine discoloration may occur due to pigment of vitamin(s). Mild detoxification reactions can occur, such as: increased fatigue, headache, increased muscle fatigue or cramping, and possible nausea, or change in bowel movements.

I am not seeking medical treatment for any body enhancement, body building or performance enhancement of any kind. I am electively seeking this treatment for legitimate medical purposes.
I will notify the provider if I play any competitive sports and I accept all responsibilities for abiding by any rules and regulations that pertain to my sport. If unsure about sports medicine regulations, I will contact my team physician, appropriate sport association, and/or regulating board.
I authorize Zen Flow IV to obtain a prescription from the medical doctor for the vitamins and medications rendered to me today or in the future.
I have read and understand the above and have had the opportunity to ask questions. I hereby consent to treatment.
Our IVs & injections are for healthy individuals. These IVs do not cure, treat or prevent any illness, health concern, condition, disease, etc. If you are considering an IV with us and have a serious, chronic or potentially fatal illness or disease we reserve the right to refuse treatment. We do NOT claim to treat, cure or aid in prevention of any sickness, cancer or diseases.

 

Physician – Patient Arbitration Agreement
Article 1: Agreement to Arbitrate: It is understood that any dispute as to medical malpractice, that is as to whether any medical services rendered under this contract were unnecessary or unauthorized or were improperly, negligently or incompetently rendered, will be determined by submission to arbitration as provided by Washington and federal law, and not by a lawsuit or resort to court process except as state and federal law provides for judicial review of arbitration proceedings.
Both parties to this contract, by entering it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration.
Article 2: All Claims Must be Arbitrated: It is also understood that any dispute that does not relate to medical malpractice, including disputes as to whether a dispute is subject to arbitration, will also be determined by submission to binding arbitration. It is the intention of the parties that this agreement bind all parties as to all claims, including claims arising out of or relating to treatment or services provided by the health care provider including any heirs or past, present, or future spouse(s) of the patient in relation to all claims, including loss of consortium. This agreement is also intended to bind any children of the patient whether born or unborn at the time of the occurrence, giving rise to any claim.
All claims for monetary damages exceeding the jurisdictional limit of the small claims court against the health care provider, and/or the health care provider’s associates/ association, corporation, partnership, employees, agents, and estate, must be arbitrated including without limitation, claims for loss of consortium, wrongful death, emotional distress, injunctive relief, or punitive damages.
Article 3: Procedures and Applicable Law: A demand for arbitration must be communicated in writing to all parties. Each party shall select an arbitrator (party arbitrator) within thirty days and a third arbitrator (neutral arbitrator) shall be selected by the arbitrators appointed by the parties within thirty days thereafter. The neutral arbitrator shall then be the sole arbitrator and shall decide the arbitration. Each party to arbitration incurred or approved by the neutral arbitrator, not including counsel fees, witness fees, or other expenses incurred by a party for such party’s own benefit. Either party shall have the absolute right to bifurcate the issues of liability and damage upon written request to the neutral arbitrator. The parties' consent to the intervention and joinder in this arbitration of any person or entity that would otherwise be a proper additional party in a court action and upon such intervention and joinder, any existing court action against such additional person or entity shall be stayed pending arbitration. The parties agree that provisions of the Washington Medical Injury Compensation Reform Act shall apply to disputes within this arbitration agreement, including, but not limited to, sections establishing the right to introduce evidence of any amount payable as a benefit to the patient as allowed by law, the limitation on recovery for non-economic losses, and the right to have a judgment for future damages conformed to periodic payments (CCP 667.7). The parties further agree that the Commercial Arbitration Rules of the American Arbitration Association shall govern any arbitration conducted pursuant to this Arbitration Agreement.
Article 4: General Provision: All claims based upon the same incident, transaction or related circumstances shall be arbitrated in one proceeding. A claim shall be waived and forever barred if (1) on the date notice thereof is received, the claim, if asserted in a civil action, would be barred by the applicable legal statute of limitations, or (2) the claimant fails to pursue the arbitration claim in accordance with the procedures prescribed herein with reasonable diligence.
Article 5: Revocation: This agreement may be revoked by written notice delivered to the health care provider within 30 days of signature of signature and if not revoked will govern all professional services received by the patient and all other disputes between the parties.
Article 6: Retroactive Effect: If a patient intends this agreement to cover services rendered before the date it is signed, it will be effective as of the date of first professional services.
If any provision of this Arbitration Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this Arbitration Agreement. 

Financial Policy

You are responsible for your entire bill at the time of service including the additional cost of any vitamins, supplements, or medications added on to treatment.
Insurance: Zen Flow IV does not accept insurance and will not bill insurance on your behalf.
In many cases, the cost of products or services received at Zen Flow IV are not covered by insurance as they may be deemed elective prevention and well-being services. Zen Flow IV does not make any representations as to whether the products or services you received will be covered or reimbursed by your insurance company. If you have questions regarding coverage, you should contact your insurance company directly.
Change of Information: You are responsible for providing Zen Flow IV current contact information.
Appointment Cancellation Charge: If you cancel an appointment with less than 24 hours' notice, or if you do not show up at your scheduled appointment, you will b
e charged
$75 for the service. You will be given a 15 minute grace period.
Form of Payment: Payments may be made in cash, by Visa, MasterCard, Discover or American Express, however we reserve the right to discontinue any of these payment methods.


Wait Time Fees

If you cannot start your appointment within 15 minutes of the scheduled start time we are happy to have our nurse wait, providing it does not cause any scheduling conflicts. Wait time is charged at $100/ hour / nurse in increments of 15 minutes and starts to accrue 30 minutes after the start of your appointment.
 

Refunds / No Show Policy
 

Payment for the full cost of services is non refundable. Cancellations will be accepted with 24 hours advanced notice. Once an IV bag is prepared for a treatment the full amount will be charged. If a patient is unfit to receive for treatment for any reason the full price of the service will be charged.
We understand that life may get in the way of your attendance to your booked appointment, however, no show appointments will be charged
$75. We reserve the right to deduct payment from your pre paid packages. In the rare case that we cannot show up for an appointment on time we will let you know and do our best to find the next available appointment time that works for you.
I acknowledge and agree that I have read, understood and agree to the terms set forth above, including, without limitation, that I am ultimately responsible for payment for all fees, regardless of insurance or other coverage.

Consent
To Treatment

I authorize Zen Flow IV to obtain a prescription from the medical doctor for the vitamins and medications rendered to me today or in the future. I have read and understand the above and have had the opportunity to ask questions. I hereby consent to treatment.
Our IVs & injections are for healthy individuals. These IVs do not cure, treat or prevent any illness, health concern, condition, disease, etc. If you are considering an IV with us and have a serious, chronic or potentially fatal illness or diseases we reserve the right to refuse treatment. We encourage our clients to consult with their primary medical doctor about all procedures about their specific medical condition and suitability for the injections contemplated by the agreement. We do NOT claim to treat, cure or aid in prevention of any sickness, cancer or diseases.
You are hereby acknowledging that you have been notified of treatment costs and restrictions and confirm that you are electing our IV and vitamin treatments for the nutritional benefits only.

Come Get That Zen

1406 E Pine St

Seattle, WA 98122

Tel: 206-939-1227

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