Medical Disclosure Form I will not hold Vitamin Drip House liable in any way for any infections / reactions that may occur directly or indirectly as a result of receiving the treatment. I thus agree to disclose to the personnel of Vitamin Drip House of any Influenza Symptoms that I may have. Including Covid - 19 essential information. I will further verbally inform Vitamin Drip House Personnel of any health problems and allergies I suffer from. I give Vitamin Drip House the right to follow and monitor the progress of my treatment for the period I spend on their premises.Consent *Yes, I agree with the above conditions. For Vitamin Drip House Professional Nurse:Arrival TimeDeparture TimeInspection Results / CommentsClient TemperatureService of interest *Energy CocktailBabalas CureLipolysis InjectionsPower PlusTrace ElementsAntioxidantFitness DripSkin GlowExtreme Skin GlowVitamin B-Co DripVitamin B12 ShotVitamin B-Co ShotMarapo DripPure Vit-CHydration DripOther, please specify CCTV Privacy Notice - Security Purposes Vitamin Drip House premises are monitored by Closed Circuit Television (CCTV) cameras which captures and keeps record for five (5) days and shares relevant units' footages which determine your identity, actions and whereabouts. Your footage may be saved for a longer duration and processed in other means should it be involved in or of use to a security measure. By entering these premises, you consent to the capture, recording, processing and sharing of all information directly and indirectly obtained by CCTV cameras.Enter your full name as acceptance of the above *Date *SavePlease do not fill in this field.
