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Intake Form & Consent
How did you hear about us?
What are your main complaints? Required
Which statements best describe why you are here today? Required
Have you ever been told that you have an electrolyte imbalance or other abnormal labs? (Please check all that apply)
Do you use any recreational drugs?
Do you take Digoxin (Lanoxin) for a heart problem?
Do you take any diuretics or water pills?
Do you take any steroids, i.e. Prednisone?
Do you have any medication or food allergies?
Do you have any of the following conditions?

Thanks for submitting! A nurse may contact you prior to visit.

*The services provided have not been evaluated or approved by the Food and Drug Administration (FDA). These products are not intended to diagnose, treat, cure, or prevent any disease. The material on this website is provided for informational purposes only and is not medical advice. Consult with your primary care provider to help you determine if IV drip therapy is the right choice for you. 

2026 by LADRU® IV DRIPS

6739 Frank Lloyd Wright Avenue, Middleton, WI

Text: 414.698.1053 Donna RN

nurse@ladruiv.com

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