Intramuscular Injection 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
Hydroxocobalamin B12
1 mg/ml
Methylcobalamin B12
1 mg/ml
B-Complex
100 mg/ml
MICC with B12
Glutathione
200 mg/ml
Ondansetron
4mg/ 2ml
Famotidine
20mg/ 2ml
Ketorolac
30mg/ml
Today's Date
Today's Date