Consent to In-Person Treatment

I consent to evaluation and treatment at Biomarker Health's clinic in Winter Park, Florida, by licensed providers practicing under Florida law and the protocols of Biomarker Health's Medical Director. Treatment may include blood draws, injections, IV therapy, vitamin therapy, and hormone therapy; some procedures require a separate consent. Risks include bruising, pain, bleeding, infection, fainting, vein irritation, and allergic reaction. My provider will explain the risks, benefits, and alternatives of any treatment before providing it. I agree to give a complete and accurate medical history, including medications, allergies, and pregnancy status. I may refuse or stop any treatment at any time. Biomarker Health does not provide emergency care; in an emergency I will call 911. I confirm I am at least 18 years old and have been offered the Notice of Privacy Practices. This consent remains in effect until I revoke it in writing.

By checking the box and submitting this form, I agree that my electronic signature has the same legal effect as a handwritten signature.