Client Intake Form

I consent to all nutrient injections rendered by the the licensed professional medical staff associated with Moon Valley Med Spa. I understand that there are risk to vitamin nutrient injections including but not limited to pain, bruising, inflammation, injury, infection, allergic reactions, headaches, dry mouth, difficulty sleeping, diarrhea, blurred vision, unpleasant taste, increase urination, cramps, and metabolic disturbances. I do not expect the persons employed or associated with Moon Valley Med Spa to anticipate and or explain all risk and possible complications. I hereby release the professional medical staff at Moon Valley Med Spa from all liabilities regarding my treatment with vitamin/nutrient injections. I understand that nutrient injections may not be approved by the United States Food and Drug Administration for the treatment of my medical condition.