INFORMED CONSENT FORM IV THERAPY
- Dr. Joshua Cooper
- Dr. Manuel Arriaga
- Dra. Andra Angeles
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Introduction
You are being offered intravenous (IV) stem cell therapy as a treatment option. This consent form provides important information to help you understand the procedure, potential benefits, and risks. Please read it carefully and ask any questions you may have before signing up.
What is IV Stem Cell Therapy?
IV stem cell therapy involves the administration of stem cells, Vitamins and minerals into your bloodstream through an intravenous (IV) line. The stem cells used are umbilical cord mesenchymal stem cells from Wharton's Jelly. and are processed in a laboratory to meet safety standards.
The goal of IV therapy is to support tissue repair, reduce inflammation, and promote healing or general wellness.
The proposed treatment aims to:
· Modulate immune system activity
· Promote regeneration of damaged tissues
· Potentially improve symptoms related:
However, no guarantees can be made regarding the effectiveness of the therapy.
Procedure
If you choose to proceed with IV stem cell therapy (vitamins and minerals), the following will occur:
1. A qualified healthcare professional will administer the stem cells via an IV line.
2. The infusion may take between 30-90 minutes.
3. You will be monitored during and after the procedure for any adverse reactions.
Risks and Potential Side Effects
Although generally considered low risk, IV stem cell therapy (vitamins and minerals) may involve:
· Fever or chills
· Headache
· Nausea
· Allergic reaction or immune response
· Infection
· Blood clots or inflammation at the infusion site
· Unknown long-term side effects
It is important to understand that stem cell therapy is still under investigation and outcomes may vary.
Potential Benefits
While some patients report improvement in symptoms, energy levels, or mobility, results are not guaranteed. Benefits may include:
· Reduced inflammation
· Pain relief
· Enhanced recovery or function
· Immune system modulation
Alternatives
Alternatives to IV stem cell therapy include:
· Conventional medical treatments for your condition
· Physical therapy
· Surgery
· Choosing no treatment
You are encouraged to discuss all available options with your physician.
Confidentiality
All personal and medical information will be kept strictly confidential and used only for the purposes of your care and any required follow-up.
Voluntary Participation and Right to Withdraw
You understand that participation in IV stem cell therapy is completely voluntary. You may refuse treatment or withdraw consent at any time, without affecting your future medical care.
Consent Statement
I confirm that I have read and understood the information in this consent form. I have had the opportunity to ask questions, and all my questions have been answered to my satisfaction. I understand the nature, purpose, potential risks, and alternatives of IV stem cell therapy, and I voluntarily agree to proceed.
Signed by: