On the day of the infusion and for 24hours after the infusion, you should NOT engage in any of the following:
- Drinking alcohol or using drugs
- Conducting business, including signing any legal documents.
- Participating in activities which require you to rely on motor skills or memory.
By agreeing to this treatment and by your signature on this form, you recognize and understand the risks involved and agree to strictly adhere to these policies after every administration of the medication.
In the event you decide to engage in the above-listed activities, you agree you do so at your own peril. In no event will Virginia Infusion Therapies, its staff, physicians, employees, or agents (collectively “the Practice”) be liable in any way for any personal injury, death, property loss or damage sustained by or through you in connection with my engagement after infusion in the above-listed activities. By your signature below, you agree to waive, release, and discharge the Practice from any and all liability, claims, demands, actions, and causes of actions whatsoever for any and all loss, claim, damage, injury, illness, fees or harm arising out of your participation after infusion in the above-listed activities.
This waiver will remain binding and in effect so long as you participate in treatment with Virginia Infusion Therapies.
Virginia Infusion Therapies
The First Ketamine Clinic in Northern Virginia
Virginia Infusion Therapies is one of the the first Ketamine Clinics in Northern Virginia, and the first clinic in Loudoun County to provide Ketamine infusion therapy for the treatment of Major Depression and Pain Conditions. The clinic was established by four physicians in Loudoun who, through their professional experiences in medicine and their personal family experiences with depression, recognized that there are major problems in the recognition and treatment of depression. They recognized that Major Depression, Post-Traumatic Stress Syndrome, and some pain conditions are often medical emergencies that requires treatments that are more effective… and more effective IMMEDIATELY.
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