Checkout – ChocoCity VitaFuse

“Vitamin Drip Elite Plan” has been added to your cart. Continue shopping

Have a coupon? Click here to enter your code

Coupon:

Billing details

— OR —

CLIENT INFO

First & Last Name *

Phone *

Date of Birth *

Consent to Medical Care & Policy Agreements *

I have read and agree to the Consent to Medical Care and Privacy Policy

SERVICE ADDRESS

Must be within District of Columbia, Maryland or Virginia

Street address *

Town / City *

State *

Zip *

QUICK SURVEY

How did you hear about us?

Internet
Social Media
Friend

CLIENT COMPLAINTS

What are your main complaints?

Fatigue or low energy
Cold or flu symptoms
Stress
Brain fog or trouble concentrating
Poor diet due to busy lifestyle
Dull or dry skin
Other (please specify below)

Other complaints

PROBLEM AREAS

Which statements best describe why you are here today?

I want to have more energy and feel better overall
I want to recover quickly from migraine/headache and hangover
I want to cleanse my body of toxins and prevent getting sick
I want to have smoother, brighter and more vibrant skin
I want to Enhance my Athletic Performance
Other (please specify below)

Other reason why you are here today

PRE-SCHEDULING FORM

Please complete the below information with accurate information to ensure a safe, quality infusion experience.

Are you or anyone in your party currently being treated for COVID-19? *

Have you been fully vaccinated for COVID-19? *

Will you have a face covering to wear during your infusion if unvaccinated? *

MEDICAL HISTORY

Do you have any medication or food allergies? *

If Yes, please list

Are you pregnant or breastfeeding? *

Do you have any of the following conditions? (Please check all that apply) *

Blood pressure problems (High or low)
Kidney Stones
G6PD Deficiency
None

Are you currently taking any Medications? (prescriptions or over the counter) *

Please list everything you are currently taking and condition being treated

BILLING DETAILS

First name

Last name

Company name (optional)

Country / Region United States (US)

Street address

Town / City

State

ZIP

Email address

Review your orders

Product	Qty	Total	Remove
	1	$940.00	x
Vitamin Drip Elite Plan

Subtotal

$940.00

Total

$940.00

Payments

Credit Card
Pay with your credit card
- Use a new payment method
Card Number *

Expiry Date *

Card Code (CVC) *

Save payment information to my account for future purchases.

Update TotalsUpdate totals

Your personal data will be used to process your order, support your experience throughout this website, and for other purposes described in our privacy policy.

Cancelation/Refund

You may cancel your appointment without charge if you cancel within 24 hours of your appointment. Last minute cancellations are charged the full amount of the service scheduled as that time has been set aside specifically for you. Please be mindful that there are no refunds however clients can request to reschedule services.

Gift Certificate

Gift certificates are non-refundable and are not redeemable for cash. Gift certificates do not expire and are transferable. ChocoCity VitaFuse LLC is not responsible for lost, misplaced, or stolen gift certificates.

Code of Ethics

ChocoCity VitaFuse LLC service providers will only work within our scope of practice. Our treatments do not take the place of those of a medical doctor. If we are unable to assist you, we will refer you to an appropriate licensed medical provider. If you have any medical condition that limits your daily fluid/water intake such as Heart failure, kidney disease, or if you receive dialysis it is your responsibility to truthfully answer the medical questionnaires and let our provider know prior to booking your appointment.

ChocoCity VitaFuse LLC is operated by board certified, licensed, and insured practitioners. Unprofessional or inappropriate behavior and conduct is strictly prohibited and will not be tolerated. If a service provider becomes uncomfortable, your session will be terminated immediately, and you will be permanently banned from the establishment.

ChocoCity VitaFuse LLC reserves the right to change policies, regulations, and pricing at any time upon providing reasonable notice.

I have read and agree to the website Term of Service & Cancellation Policy *