Infusion Bar Form Name * First Name Last Name Email * Date of Birth * MM DD YYYY Phone * (###) ### #### Select Your Infusion Bar Service * Vitamin D3 - $20 Vitamin B12 - $20 Lipo + $25 / Special – 4 weeks $75 Hydration Drip - $99 Custom IV Drip - $100 (with $25/add on) Immunity Boost Drip - $125 B-Lean Drip - $175 Bloom Boost Drip (Our version of the famous Myers' Cocktail) - $175 Bloom Beauty Drip - $175 Hangover Relief Drip - $200 Migraine Pain Relief Drip - $225 NAD+ - $350 Add-Ons for Custom IV Drip (Optional) (Only select if you booked a Custom IV Drip) Vitamin C Boost (+$25) Glutathione Push (+$25) B-Complex (+$25) Zinc Boost (+$25) Anti-Nausea Medication (+$25) Preferred Appointment Date * MM DD YYYY Preferred Appointment Time * Morning Afternoon Evening Additional Notes or Requests Anything you'd like us to know before your visit? Thank you! Your request has been received. Our team will contact you shortly to confirm your appointment and answer any questions you may have. We look forward to helping you feel your best!
