iv-therapy-assessment IV Nutrient Therapy Assessment Please complete this form so we can understand your health goals and arrange the appropriate medical assessment. Step 1 of 4: About You Website First name *Last name * Date of birthTelephone * Email * How did you hear about us?Please selectFriend or familyExisting patientGoogle SearchInstagramFacebookTikTokYouTubeHealthcare professionalAnother clinicAdvertisementOther What would you like support with? (Select all that apply) General health and wellbeing Low energy or fatigue Frequent infections Recovery after illness High stress Poor sleep Exercise recovery Brain fog Healthy ageing Skin health Hair health Weight management Joint pain or stiffness Arthritis Chronic pain Migraines Digestive health Other Please tell us more about your main health concern(s) or goal. Have you been diagnosed with any medical conditions? Please list them. Are you taking any regular medication or supplements? What prompted you to consider IV nutrient therapy at this time? Are you currently experiencing any of the following? Persistent tiredness Frequent infections Poor sleep High stress levels Brain fog Headaches Low mood Poor exercise recovery Hair thinning Dry skin Digestive problems Joint pain or stiffness None of the above Average sleepSelectLess than 5 hours5–6 hours7–8 hoursMore than 8 hoursStress levelSelectLowModerateHigh Exercise frequencySelect0 days per week1–2 days per week3–4 days per week5 or more days per week What would make this treatment a success for you? I consent to being contacted by Dr. Don Aesthetics via email, text (SMS/WhatsApp) and telephone calls for appointment reminders, health information and treatment updates. * Submitting this form does not confirm suitability for treatment. A medical assessment is required before any IV nutrient therapy is provided. BackContinueSubmit Assessment