Practice
Navara Health, PLLC
5301 Alpha Road, Suite 34, Room 21
Dallas, Texas 75240
Contact
469-653-3124
contact@navarahealthtx.com
Treating Provider (APRN)
Jessica Boggs, MSN, APRN, FNP-C, ENP-C
RN Administrator (Under Delegation)
Rocio Gonzalez, RN
Medical Director
Simal Patel, MD
Service Class
IV infusion & intramuscular / subcutaneous injection therapy
Provider Scope & Delegation
Who Will Administer My IV or Injection
IV infusion and injection therapy at Navara Health may be administered by either:
- Jessica Boggs, APRN, FNP-C, ENP-C — the prescribing and supervising advanced practice provider
- Rocio Gonzalez, RN — operating under Jessica Boggs' APRN delegation, standing orders, and protocols in accordance with Texas Board of Nursing rules. A Good Faith Exam (GFE) is performed by Jessica APRN prior to or at the time of any IV therapy administered by the RN.
The actual administering clinician for today's treatment will be documented at the signature page of this consent. Regardless of which clinician administers, all treatments occur within established Navara Health protocols, scope of practice, and supervisory authority.
Purpose & Description of Treatment
I understand that I may receive intravenous (IV) infusion therapy and/or injectable therapy at Navara Health, PLLC ("the Practice").
IV Infusion Therapy
Involves the placement of a peripheral intravenous catheter into a vein, through which fluids, vitamins, minerals, nutrients, amino acids, antioxidants, and/or medications are administered directly into the bloodstream. Infusions typically take 30–90 minutes, depending on volume and ingredients.
Injection Therapy
Involves the administration of vitamins, minerals, nutrients, peptides, or medications into the subcutaneous tissue (under the skin) or intramuscularly (into muscle). Common examples include B12, MIC/lipotropic injections, vitamin D, glutathione, NAD+, and others.
I understand that these therapies are provided as elective wellness or supportive treatments and are not considered medically necessary. They are not intended to diagnose, treat, cure, or prevent any disease.
FDA & Regulatory Status
I acknowledge and understand that:
- Many IV and injectable therapy ingredients are compounded preparations dispensed by a licensed 503A or 503B compounding pharmacy
- Compounded preparations are not FDA-approved as finished drug products and have not undergone FDA pre-market safety, efficacy, or manufacturing review for the specific compounded formulation
- Most IV nutrient/vitamin therapies are not FDA-approved for the specific wellness indications for which they are being administered
- NAD+ is not FDA-approved for anti-aging, longevity, or cognitive indications
- High-dose vitamin C is not FDA-approved for the indications for which it is sometimes administered
- Off-label use of legally obtained medications and compounded preparations is permitted in clinical practice at the provider's discretion
- I am voluntarily electing this therapy with full awareness of its regulatory status
Elective Nature & Alternatives
I acknowledge that IV and injectable therapies are optional and elective. Reasonable alternatives include, but are not limited to:
- No treatment
- Oral supplementation through Fullscript or other sources (see Navara Supplement Consent)
- Dietary or lifestyle modification
- Hydration with oral electrolyte solutions
- Ongoing care with a primary care provider, gastroenterologist, or specialist for underlying conditions
- FDA-approved alternatives for specific symptoms or conditions
I understand that I may decline or discontinue treatment at any time without penalty.
General Risks, Side Effects & Complications
Common
Local IV / Injection Site Reactions
Pain, irritation, redness, bruising, or bleeding at the IV or injection site. Mild discomfort during catheter placement. Temporary tenderness at the site. Cold sensation in the arm during infusion. These typically resolve within hours to days.
Less Common
Treatment-Related Effects
Infection at the IV/injection site (rare with proper aseptic technique). Phlebitis (vein inflammation, may cause cord-like tenderness for days to weeks). Tissue injury or infiltration (medication leaks into surrounding tissue rather than the vein). Dizziness, fainting, or lightheadedness. Transient blood pressure changes. Transient blood sugar fluctuations. Fluid overload (rare; more likely in patients with cardiac or renal compromise). Vasovagal response (common, usually self-limited). Metallic taste during infusion (with certain nutrients).
Rare but Serious
Significant Adverse Events
Severe allergic reaction or anaphylaxis — including hives, throat tightness, breathing difficulty, hypotension.
Sepsis or bloodstream infection — rare with proper aseptic technique.
Blood clots (thrombosis) at IV site.
Air embolism (extremely rare with proper technique).
Cardiac arrhythmia or chest pain (rare; some IV nutrients can cause transient effects).
Severe medication or nutrient interactions.
Hemolysis (red blood cell destruction) in G6PD-deficient patients receiving high-dose vitamin C (see Section 6).
Pneumothorax (extremely rare; not expected with peripheral IV).
I understand that unforeseeable complications may occur despite appropriate screening and technique.
Vitamin-Specific Risk Disclosure
Specific nutrients commonly administered intravenously or by injection carry their own risk profiles that warrant individual disclosure. The following are the most clinically important:
High-Dose Vitamin C (Ascorbic Acid) — Critical G6PD Risk
G6PD deficiency contraindication: High-dose intravenous vitamin C (typically >7.5 g) can cause severe, life-threatening hemolysis (red blood cell destruction) in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. G6PD testing is required before high-dose vitamin C infusion at Navara Health (see Section 6). Other risks: nausea, increased urination, possible kidney stone formation (with high doses, especially in patients with kidney disease or oxalate stone history), and interference with chemotherapy (consult oncology if applicable).
Vitamin B6 (Pyridoxine)
Peripheral neuropathy risk: Chronic high-dose B6 exposure (typically >100 mg/day over time, but acute high doses also documented) can cause sensory peripheral neuropathy — numbness, tingling, or burning in the hands and feet. This neuropathy is usually reversible with discontinuation but can persist. Patients on compounded GLP-1 medications containing B6, IV B-complex, or B6 supplements should disclose all sources of B6 intake to avoid cumulative dosing.
Glutathione
Hypersensitivity risk: Rare but documented hypersensitivity reactions, including Stevens-Johnson syndrome (severe skin reaction), have been reported, particularly in Asian populations. Patients with a history of severe drug allergies, severe skin reactions, or family history of SJS/TEN should disclose this. Other potential effects: transient sulfur-like taste or odor, mild lightheadedness, and rare allergic reactions.
NAD+ (Nicotinamide Adenine Dinucleotide)
Flushing and chest pressure: NAD+ commonly causes a "rushing" or "wave" sensation, chest pressure, abdominal cramping, headache, and a feeling of being out of breath during infusion. These sensations are dose- and rate-dependent — slower infusion rates substantially reduce these effects. Symptoms typically resolve within minutes of slowing or pausing the infusion. NAD+ is administered slowly over 2–4 hours to minimize these effects. NAD+ is not FDA-approved for anti-aging, longevity, or cognitive indications.
B-Complex / B12 (Methylcobalamin or Cyanocobalamin)
Allergic reaction (rare): Most patients tolerate B-vitamins well. Rare allergic reactions to B12 or B-complex have been reported. Bright yellow urine is normal after riboflavin (B2) administration and is not harmful. High-dose methylated B vitamins can produce mild anxiety or restlessness in sensitive patients.
Biotin (B7)
Lab interference: High-dose biotin (typically >5 mg) can interfere with many laboratory tests that use biotin in their assay methodology — including thyroid (TSH, free T4, T3), troponin, hCG, hormone panels, and others. Discontinue biotin at least 72 hours before laboratory draws to avoid falsely elevated or suppressed results. This applies to oral biotin supplements as well as IV biotin.
Magnesium
Hypotension and respiratory depression: Rapid IV magnesium administration can cause significant hypotension, warmth/flushing, and (in high doses) respiratory depression and cardiac arrhythmia. Magnesium is administered slowly. Patients with renal impairment, neuromuscular disease, or on certain medications (e.g., calcium channel blockers) may have increased risk and should disclose these.
Calcium
Cardiac and tissue effects: Rapid IV calcium can cause cardiac arrhythmia. Extravasation (leakage outside the vein) can cause severe tissue injury including necrosis. Calcium is administered slowly with careful monitoring.
Amino Acids (Glutamine, Arginine, Carnitine, Taurine, etc.)
Generally well-tolerated. Rare allergic reactions. L-arginine may lower blood pressure and interact with blood pressure medications. Patients with herpes simplex (cold sores) may want to discuss L-arginine as it may trigger outbreaks in some patients.
Lipotropic Injections (MIC, MIC+B12)
Methionine, inositol, choline (MIC) injections may cause warmth, brief soreness at injection site, mild diuresis, or rare allergic reaction. Generally well-tolerated.
Zinc
High-dose IV zinc can cause nausea, metallic taste, and interfere with copper metabolism with chronic dosing. Generally well-tolerated at standard wellness doses.
This list is not exhaustive. Other compounds may be administered with their own risk profiles, which will be discussed at the time of treatment.
G6PD Deficiency Screening Protocol for High-Dose Vitamin C
Required Safety Protocol · High-Dose Vitamin C Infusion
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic enzyme deficiency that affects red blood cell stability. Patients with G6PD deficiency receiving high-dose vitamin C can experience severe, potentially life-threatening hemolysis (red blood cell destruction).
Navara Health Protocol:
- G6PD testing is required before high-dose vitamin C infusion (typically defined as >7.5 g per infusion)
- G6PD testing must be on file before the first high-dose infusion. Results are valid indefinitely (G6PD status does not change).
- Patients with documented G6PD deficiency will not receive high-dose vitamin C infusions
- Low-dose vitamin C (typically <2.5 g) in Myers' Cocktail and similar formulations does not require G6PD screening
- G6PD deficiency is more common in patients of African, Mediterranean, Middle Eastern, and South Asian descent, but can occur in any population
- I confirm I have either completed G6PD testing or do not require high-dose vitamin C; if high-dose vitamin C is added to my treatment plan, G6PD testing will be obtained before infusion
Pre-Procedure Hold & Disclosure Requirements
Pre-Procedure Safety Disclosures
What I Will Disclose Before IV / Injection Therapy
Before each IV or injection treatment, I will disclose the following to my provider or nurse:
- Blood thinners or antiplatelet medications — warfarin, apixaban, rivaroxaban, dabigatran, aspirin, clopidogrel. These may increase bruising risk at IV/injection sites. The clinician may use additional pressure and longer compression at the site.
- Bleeding-risk supplements — fish oil/omega-3, garlic, ginkgo, ginger (high dose), turmeric/curcumin, vitamin E (high dose), nattokinase, bromelain. May increase bruising.
- Current hydration status — I have had at least some fluids in the past 4 hours (avoiding strict fasting/dehydration before IV therapy makes vein access easier and reduces vasovagal risk).
- Recent meals — IV therapy can be administered without fasting; however, very low blood sugar or strict fasting can increase vasovagal risk during infusion.
- Current diuretic use — may affect fluid and electrolyte balance during infusion.
- Recent surgery or aesthetic procedures — may affect infusion timing or location of IV site.
- Active illness, fever, or acute infection — typically defer elective IV therapy.
- All current medications, supplements, peptides, hormones, and recent biotin use.
- Pregnancy or possible pregnancy, and breastfeeding status.
- All known allergies, including drug allergies, food allergies (especially shellfish for any IV containing alpha lipoic acid or shellfish-derived ingredients), and environmental allergies.
- G6PD status if high-dose vitamin C is planned (see Section 6).
- Cardiac, renal, or hepatic disease history — may affect fluid tolerance, electrolyte balance, and infusion rates.
Failure to disclose these factors may increase my risk of adverse effects.
Potential Benefits (Not Guaranteed)
I understand that potential benefits may include, but are not guaranteed:
- Improved hydration
- Faster absorption of nutrients compared to oral intake (bypassing GI absorption limitations)
- Temporary symptom relief (fatigue, dehydration, post-workout recovery, hangover, immune support, etc.)
- Support for wellness, performance, recovery, and athletic preparation
- Nutrient repletion in patients with documented deficiencies
- Subjective improvement in energy and overall well-being
I understand that results vary substantially between individuals, and no guarantees have been made regarding effectiveness.
Contraindications & Cautions
IV or injection therapy may be contraindicated, deferred, or require modification if I have or disclose:
- Known hypersensitivity to any planned ingredient
- G6PD deficiency (precludes high-dose vitamin C)
- Active uncontrolled cardiac disease, severe congestive heart failure, or severe renal impairment (fluid overload risk)
- Severe pulmonary disease
- Active uncontrolled hypertension
- Active infection, fever, or acute illness
- Pregnancy or breastfeeding (case-by-case clinical judgment; some IVs may be acceptable, others not)
- Severe phobia of needles preventing safe IV placement
- Recent chemotherapy (some IV nutrients may interfere; coordinate with oncology)
- Active oncology treatment without coordination with the oncology team
- Severe coagulation disorder
- Inability to provide accurate medical history or consent
- Significant intoxication at time of presentation
Per-Treatment Acknowledgment
Documentation of Specific Treatments (For Use At Each Visit)
Each time IV or injection therapy is administered, the following table will be completed by the administering clinician and reviewed with me. My initials in the right-hand column confirm I understand the specific treatment and its risks, and have been given the opportunity to ask questions. This block may be left blank at initial signing and completed at each visit thereafter.
| Treatment Name / Formula | Dose / Volume / Route | Lot # (if applicable) / Notes | My Initials |
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Visit Date: __________________ Administering Clinician (Print Name): __________________ Clinician Initials: __________
Important Acknowledgments
By proceeding with treatment, I acknowledge and agree that:
- I have had the nature, risks, benefits, limitations, and alternatives explained to me
- I have had the opportunity to ask questions and all questions have been answered to my satisfaction
- The provider cannot anticipate or explain every possible complication
- I will immediately notify staff of any discomfort, side effects, allergic reactions, or unusual sensations during or after infusion
- In the event of a medical emergency, I understand that 911 will be called or I will be directed to emergency care
- I have disclosed all known allergies, medical conditions, medications, supplements, peptides, hormones, and other therapies
- I understand that these services are not intended to diagnose, treat, cure, or prevent any disease
- I understand that many IV and injectable therapies are not FDA-approved for specific indications for which they are administered
- I understand that functional or wellness laboratory testing (blood, urine, saliva, stool, hair, or skin) may be recommended and that I am financially responsible for any associated lab fees
- I will continue routine care with my primary care provider and/or mental health provider
- I understand that Navara Health is not my primary care provider unless I have separately enrolled in the Direct Primary Care (DPC) program
Communication & HIPAA Authorization
I authorize Navara Health to communicate with me regarding scheduling, treatment, follow-up, and adverse event reporting through:
- The secure HIPAA-compliant patient portal
- Email to the address I have provided
- SMS / text message to the mobile number I have provided
- Telephone calls to the number I have provided
I understand that email and SMS are not fully secure channels. I may revoke authorization for any specific channel in writing to contact@navarahealthtx.com.
Assumption of Risk & Limitation of Liability
I voluntarily assume all known, unknown, and unforeseen risks associated with IV infusion and injection therapy. To the fullest extent permitted by law, I agree to release, indemnify, and hold harmless:
- Navara Health, PLLC
- Jessica Boggs, MSN, APRN, FNP-C, ENP-C
- Rocio Gonzalez, RN, and any other administering clinician
- The medical director and all affiliated providers, nurses, staff, contractors, and agents
from liability related to IV or injectable therapy, including but not limited to:
- Local site reactions, bruising, infection, or phlebitis
- Allergic or hypersensitivity reactions
- Lack of expected response or treatment failure
- Outcomes related to undisclosed medical history, medications, supplements, allergies, or G6PD status
- Adverse effects related to failure to follow post-treatment care
- Long-term or delayed effects not yet known
This release does not apply to cases of gross negligence or willful misconduct, and does not waive any right that cannot lawfully be waived under the laws of the State of Texas.
Dispute Resolution & Governing Law
Any dispute, controversy, or claim arising out of or relating to this Consent or IV/injection therapy provided by Navara Health shall first be addressed by good-faith negotiation. If not resolved within thirty (30) days, the parties agree to submit the dispute to binding arbitration in Dallas County, Texas, under the rules of a recognized arbitration body. The parties waive the right to a jury trial.
This Consent shall be governed by the laws of the State of Texas. If any provision is found unenforceable, the remaining provisions shall remain in full force and effect.
Patient Initials — Required for Each Critical Clause
Each of the following requires my separate written initials.
I understand that compounded IV/IM preparations are not FDA-approved as finished drug products, and that many wellness applications are off-label.
I understand the vitamin-specific risks in Section 5, including B6 peripheral neuropathy risk, biotin lab interference (72-hour rule), and other compound-specific risks.
I understand the G6PD deficiency protocol in Section 6 — G6PD testing is required before high-dose vitamin C infusion, and patients with G6PD deficiency cannot receive high-dose vitamin C.
I agree to the pre-procedure disclosures in Section 7, including blood thinners, supplements, hydration, pregnancy, allergies, and current medications at every visit.
I understand the per-treatment acknowledgment block (Section 10) will be completed at each visit documenting the specific IV or injection administered.
I understand IV/injection therapy may be administered by Jessica Boggs APRN or Rocio Gonzalez RN under APRN delegation, and the actual administrator will be documented at signature.
I agree to binding arbitration as described in Section 14 and understand that I am waiving the right to a jury trial.
Acknowledgment & Electronic Consent
By signing below (or by typing my full legal name as an electronic signature), I confirm and agree:
- I am at least 18 years of age.
- I have read and understand this IV Infusion & Injection Therapy Informed Consent in its entirety.
- I understand the regulatory status (compounded, off-label) of many IV/IM preparations.
- I understand the general and vitamin-specific risks, including G6PD considerations for high-dose vitamin C.
- I have completed the pre-procedure disclosures in Section 7.
- I understand the Per-Treatment Acknowledgment block (Section 10) will be completed at each visit.
- I have disclosed my complete medical history, allergies, medications, supplements, peptides, hormones, and reproductive status.
- I have had the opportunity to ask questions, and all questions have been answered to my satisfaction.
- I voluntarily consent to IV infusion and/or injection therapy as discussed with my provider.
- I authorize communication through the channels described in Section 12.
- I voluntarily assume all risks and agree to the release of liability described in Section 13.
- I agree to binding arbitration as described in Section 14.
- I have completed the Patient Initials block above.
- My typed name serves as my legal electronic signature, equivalent to a handwritten signature, and this consent becomes part of my permanent medical record.
Today's Administering Clinician (Print Name)
G6PD Status (Tested / Not Tested / N/A)
Last Biotin Use (Date) — If Within 72 Hrs of Recent Labs
Patient Signature (or Typed Electronic Signature)
Administering Clinician Signature