SECTION 1: OZONE / UV IV THERAPY (STANDARD & HI‑DOSE MAH WITH UBI)

Introduction

This section provides information about Ozone/UV IV Therapy, including Standard and Hi‑Dose Major Autohemotherapy (MAH) with Ultraviolet Blood Irradiation (UBI). Please read carefully and ask any questions before consenting to treatment.

Purpose of Therapy

Ozone/UV IV Therapy involves withdrawing a portion of your blood, mixing it with medical‑grade ozone, and re‑infusing it while passing through ultraviolet (UV) light. Hi‑Dose therapy uses a larger blood volume and dual UV exposure for enhanced potency.

Intended benefits may include:

• Enhanced oxygen utilization
• Improved circulation
• Immune system support
• Detoxification
• General wellness

Procedure Overview

Standard O3UV

• Blood Volume: 60–120cc
• UV Exposure: Single pass
• Duration: 30–60 minutes
• Method: Syringe

High‑Dose O3UV

• Blood Volume: 300cc
• UV Exposure: Dual pass
• Duration: 60–75 minutes
• Method: Infusion pump

Blood is drawn, mixed with ozone for several minutes, and re‑infused through an IV line that passes through UV light.

Potential Benefits

• Enhanced immune function
• Improved oxygenation and circulation
• Symptom relief from chronic infections or inflammation
• Support for detoxification
• Increased energy and overall wellness

Potential Risks & Side Effects

• Pain, bruising, or infection at the injection site
• Allergic reactions (rare)
• Dizziness or lightheadedness
• Hemolysis (if ozone concentration is too high)
• Herxheimer reaction (temporary symptom flare‑up)
• Fatigue or malaise
• Rare complications when therapy is properly administered

Contraindications

Please inform your Infusion Team if you have:

• Current use of antibiotics or light‑sensitizing medications
• G6PD deficiency
• Allergy to heparin, anticoagulants, or ozone
• Severe cardiovascular disease
• Hyperthyroidism
• Bleeding disorders
• Recent heart attack or stroke
• Severe anemia
• Acute alcohol intoxication
• Pregnancy or breastfeeding

Patient Responsibilities

• Disclose all medications, supplements, and treatments
• Follow all pre‑ and post‑treatment instructions
• Report any adverse reactions immediately

SECTION 2: NUTRITION THERAPY (IV / IM)

IV Nutrition Therapy delivers fluids, electrolytes, vitamins, minerals, and other nutrients directly into the bloodstream to support hydration, wellness, recovery, and symptom relief. Common reasons include dehydration, fatigue, immune support, athletic recovery, migraine relief, and general wellness.

Treatment Description

IV therapy involves inserting a sterile catheter into a vein to administer fluids and nutrients. IM injections deliver nutrients into muscle tissue. Formulations are selected based on your goals, symptoms, and provider recommendations.

Potential Benefits

• Improved hydration
• Increased energy
• Enhanced immune function
• Reduced fatigue
• Symptom relief (migraine, nausea, hangover, jet lag)
• Support for wellness and recovery

Individual results vary and are not guaranteed.

Potential Risks & Side Effects

• Pain, bruising, or discomfort at the injection site
• Infection
• Inflammation or phlebitis
• Allergic reactions
• Dizziness or lightheadedness
• Fluid overload (rare)
• Electrolyte imbalance
• Vein irritation or infiltration

Notify your provider immediately if you experience unusual symptoms.

Contraindications / Disclosure Requirements

I acknowledge that I have informed my provider of:

• Any chronic medical conditions
• Heart, kidney, or liver disease
• Pregnancy or breastfeeding
• Allergies to medications or supplements
• Current medications, including infusions or injections
• Recent illness, hospitalization, or surgery

SECTION 3: INTRAMUSCULAR OR SUBCUTANEOUS NUTRIENT THERAPY (IM / SQ)

Purpose of IM / SQ Therapy

IM and SQ therapies deliver vitamins, minerals, and glutathione directly into muscle or subcutaneous tissue, bypassing the digestive system. These methods are beneficial for individuals with nutrient deficiencies or absorption issues.

Procedure Description – IM Injection

• A needle is inserted into the thigh, shoulder, or upper buttocks.
• Nutrients are injected directly into the muscle.
• This method allows for higher absorption and avoids gastrointestinal irritation.

Procedure Description – Subcutaneous Injection

• Pinch approximately 1 inch (2.5 cm) of fatty tissue.
• Insert the needle into the pinched skin at a 90° angle (or 45° if limited fatty tissue).

Potential Benefits

• Bypasses digestive absorption issues
• Allows higher dosing without GI side effects
• May benefit conditions such as achlorhydria, PPI use, or pernicious anemia

Potential Risks & Side Effects

• Redness, bruising, swelling, or pain at the injection site
• Infection or nerve/muscle injury
• Allergic reactions (e.g., B12, lidocaine)
• Mild GI symptoms, dizziness, itching, or increased urination
• Rare: severe allergic reaction or anaphylaxis

Contraindications

• Liver or kidney dysfunction
• Sensitivity to cobalt or cobalamin (B12)
• Leber’s disease (B12 contraindicated)

Alternatives

• No treatment
• Oral or transdermal supplementation
• Dietary and lifestyle changes

Additional Disclosures

• Complications: Unforeseeable complications may occur. Notify your nurse of any unusual sensations.
• Scientific Status: IM Therapy may be considered unproven by some physicians and is not standard medical care.
• FDA Status: These therapies are not evaluated or approved by the FDA to diagnose, treat, cure, or prevent disease.
• Insurance: Not covered by insurance. Full payment is the patient’s responsibility.
• No Guarantees: Results vary by individual. Regular dosing may be required. No outcome is guaranteed.
• Medical Accuracy: You confirm that all medical history, medications, and allergies have been truthfully disclosed.
• Pregnancy Notice: Female clients certify they are not pregnant or breastfeeding.
• Refund Policy: All package purchases are non‑refundable. By purchasing a package, you acknowledge and agree that no refunds will be issued, regardless of usage or completion status.

Confidentiality

Your medical records and treatment details will be kept confidential in accordance with applicable laws. Only authorized personnel will have access unless you provide written consent.

NO REFUND POLICY

I acknowledge and agree to the following payment and service terms:

1. All payments for services, packages, memberships, and treatments are final.

Once a purchase is made, no refunds will be issued for any reason, including but not limited to:

• Change of mind
• Failure to complete scheduled treatments
• Scheduling conflicts
• Perceived or actual lack of results
• Relocation or inability to attend appointments

2. Prepaid packages, series, and credits do not expire unless otherwise stated, and may be used at any future date. They may not be transferred, exchanged, or converted into other services or products.

3. Missed or late‑cancelled appointments may result in forfeiture of the session in accordance with the clinic’s cancellation policy.

4. I understand that wellness, IV therapy, ozone therapy, and IM/SQ nutrient injections produce variable results.

No specific outcome is guaranteed, and lack of desired results does not constitute grounds for a refund.

PATIENT CONSENT STATEMENT

By signing below, I confirm and agree that:

• I have read this entire Informed Consent, or it has been read to me, and I understand the information provided.
• The nature of IV/IM Therapy, including potential risks, benefits, and alternatives, has been explained to me.
• I have had the opportunity to ask questions, and all questions have been answered to my satisfaction.
• I understand that these treatments involve risks and complications as described, and I voluntarily accept all associated risks.
• I give my informed consent to receive IV or IM Therapy administered by the IV Team at The Whole List Doc, under the supervision of Dr. Saima Khawaja, MD.