Get Visceral Synergy

This guide provides a comprehensive overview of how to complete the Visceral Synergy form for intravenous therapy treatment using glutathione. Follow the steps outlined here to ensure that all necessary information is submitted correctly and securely.

Follow the steps to properly complete the Visceral Synergy form.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by entering your name in the designated space on the form to authorize the physician, Ron Mariotti, ND, for the IV procedure.
3. Proceed to review the list of possible benefits of glutathione. Indicate your understanding of each benefit by initialing next to each statement.
4. Next, review the risks associated with glutathione therapy. Initial next to each risk to confirm your understanding.
5. Carefully read the contraindications and cautions provided. Again, initial next to each item to show that you have acknowledged these warnings.
6. Review the possible side effects section in detail and initial next to each item to confirm your comprehension of potential effects.
7. Once all sections are completed, date the form and enter the time of signing.
8. Finally, sign the form as the patient or have your representative or guardian sign if applicable. Ensure that you keep a copy for your records if requested.

Complete your Visceral Synergy form online today for a smooth and efficient process.