Legal Disclaimer:

I hereby give my consent to the nurses at Vitam In Fusion/ Covid SA to provide the specific treatment I have requested in the form of intravenous (IV) vitamin drips. I am aware that all forms of treatment including IV therapy may have unforeseen risks and there is always a possibility of an adverse reaction. I am aware of the advantages and risks associated with receiving vitamin IV infusions and do so at my own risk. I acknowledge that Vitam In Fusion/ Covid SA is a nurse-facilitated practice.

Furthermore, I have been truthful in answering all questions related to my health and general well-being, and I do not hold Vitam In Fusion/ Covid SA liable for any complications that may arise from the chosen IV therapy received.

Disclaimer of liability in respect of injury or harm.

The client and/or the signatory agree that Vitam In Fusion/Covid SA will not be liable for any and all claims arising directly or indirectly from any injury or harm of whatsoever nature suffered by the client and/or the signatory, however caused, proved against Vitam In Fusion / Covid SA and any of its directors/employees for loss or damage, including consequential damage, or expenses suffered or incurred by the client and/or the signatory.

By affixing his/her signature hereto, the client and/or signatory confirms that he/she does so willingly and without any duress of any nature and confirms furthermore that he/she agrees to these terms and conditions and that no misrepresentation with regard to the content hereof has been made by Vitam In Fusion / Covid SA or any of its employees.

POPIA Compliance
By completing this Client Information and Consent form you the undersigned hereby acknowledge and consent that Vitam In Fusion/ Covid SA may collect, hold, organize, store, use and administer personal information of the individual for the purpose of enabling Vitam In Fusion/Covid SA to effect the service provided to you on our operating system, register the individual for loyalty points, and send communication (which you will be able to opt out of at any time if you so choose). The Personal information may be used for the administration and enforcement of any applicable laws. The information will be held securely and wherever Vitam In Fusion/Covid SA commissions other organisations to provide support services, Vitam In Fusion/ Covid SA will bind its service providers to its privacy policies as far as may be required to have access to their customers and service providers personal information to perform such services. By entering my name below, I provide digital consent.