The NAD+ IV Infusion Consent & Screening is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (client) and, by default, expires 30 days after it is sent if left unsigned. It covers nad, iv therapy, infusion, nicotinamide, wellness, consent. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# NAD+ IV Infusion Consent & Screening > **Important — not medical advice.** For use by a licensed/qualified provider; a thorough clinical screening including current medications, renal function history, and cardiovascular status is mandatory before any NAD+ IV infusion. NAD+ IV infusion is not FDA-approved to treat, cure, or prevent any disease; it is administered as an off-label wellness service under licensed medical supervision. --- ## Facility & Client Information **Facility / Clinic Name:** ___________ **Supervising Provider (MD, DO, NP, or PA):** ___________ **Infusion Date:** ___________ **Client Full Name:** ___________ **Date of Birth:** ___________ **Phone Number:** ___________ **Email Address:** ___________ **Referring Physician (if applicable):** ___________ **Emergency Contact Name:** ___________ **Emergency Contact Phone:** ___________ --- ## Infusion Parameters **Primary Goal / Indication:** ___________ **If other, describe:** ___________ **NAD+ Dose (mg):** ___________ **Other dose:** ___________