Recovery & Performance Drip Form

 
TKH2O Pro Flo Master Name *
TKH2O Pro Flo Master Name
Client Information
Client Name
Client Name
Date
Date
Date of Birth
Date of Birth
Ascorbic Acid
500 mg/ml 3-5 ml
Amino B12
3-5 ml
Vita Plus
200 mg/ml
Glutathione
200 mg/ml 3-5ml IVP at end of infusion
Mineral Blend
80mg/1mg/20mcg/0.2mg/4mcg 3ml - 5ml
*IF FIRST DRIP START WITH 3ML EACH, 2ND+ GIVE 5ML EACH.
Time IV Started
Time IV Started
Time IV Ended
Time IV Ended
Date
Date