Required Before Your First Appointment or Order

HEALTH HISTORY
+ CONSENT.

Complete this form once before your first service. Our clinical team reviews every submission to ensure your care is safe and appropriate for you.

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HIPAA Compliant Clinician Reviewed Secure Submission
10-15 Minutes Complete once for all services
Clinician Review Licensed professional reviews every form
HIPAA Protected Your data is never shared without consent
Applies to All Services Shipped products, IV therapy, and aesthetics
Health History + Consent
Required
Your information is protected under HIPAA and is never shared without your written consent. Questions? Contact our team.

Clinician-guided wellness, longevity, recovery and aesthetic care — with shipped programs and in-person services.

Axiom IV Hydration Inc. DBA Axiom Healthspan 21 Gay St Ste 902, Phoenixville, PA 19460
(267) 489-1917  •  [email protected]
Mon-Fri 10:00 AM-7:00 PM EST  •  Sat-Sun 10:00 AM-4:00 PM EST

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© 2026 Axiom IV Hydration Inc. DBA Axiom Healthspan. All rights reserved.

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These statements have not been evaluated by the Food and Drug Administration. Axiom Healthspan products and services are not intended to diagnose, treat, cure, or prevent any disease. All products require a clinician review prior to dispensing. Always consult with a qualified healthcare provider before starting any new health program or protocol. Individual results may vary.