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Waiver

Please indicate which applies to you to determine if IV hydration therapy is needed:

1. Undergoing heavy strenuous exercise in preparation for non-professional sports event. Please note that professional and elite athletes are limited by World Anti-Doping Code (WADC) on the location, indications and rate of delivery of IV fluids and infusions.

2. Undergoing heavy strenuous activity for work without adequate time to replace fluids, salt and nutrients by oral ingestion.

3. Had severe vomiting and/or diarrhea and experiencing symptoms (dizziness, weakness, low urine output or dry mouth) despite oral ingestion of fluids and cessation of diarrhea.

4. Had high fever and feeling weak, dizzy and dry with inability to increase fluid intake.

5. Had consumed high amounts of alcoholic beverages and experiencing nausea, vomiting, epigastric pain and headache; unable to ingest adequate fluids.

6. Had completed a long-haul air transportation and experiencing nausea, headache and weakness.

A medical professional will review your situation and will get back to you right away.

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      1515 Market Street Suite 1200

      Philadelphia, PA 19102

      (717) 418-3224

      150 North Radnor Chester Road Suite F200

      Radnor, PA 19087

      (717) 418-3224

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