Pre-Consultation & Consent Form

After submitting, if eligible, you’ll receive a booking link by email.

Please fill out the following form.

First name

Last name

Email

Date of birth

Day

Month

Year

If you ticked or answered yes to any of the questions above, please supply additional information below:

Substance Use *Note: This information is used only to ensure your safety

I have consumed alcohol in the last 24 hours

I use recreational drugs (occasionally or regularly)

I am currently hungover or recovering from a night out

I am not currently not on recreational drugs or drank alcohol

⛔ I understand:

IV infusions are not a substitute for medical treatment.
High-dose nutrients carry risks in certain individuals.
All information shared is confidential and used only for my care.

I declare that the info I’ve provided is accurate and complete.

Signature and Date

Thank you for your interest. Based on your answers, this treatment may not be suitable for you at this time. Your safety and wellbeing are our priority

I agree to receiving exclusive updates and offers regarding products and services via email from I.VY by Auraé.

Fixed price

£50