Information/Screening/Acknowledgement Form

I acknowledge by scheduling with SyxPoint Medical, I agree to our cancellation policy. Appointments cancelled with less than the required notice or missed without communication may be subject to a cancellation fee to respect provider time and mobile travel commitments.*

I acknowledge that SyxPoint Medical provides mobile services within a 35-mile concierge radius. Appointments scheduled outside this area may require an additional travel fee; however, a member of our team will contact you prior to your appointment to review any applicable charges and confirm your approval before services are provided.*

I acknowledge that at SyxPoint Medical, gratuities are never expected. Our commitment is to provide safe, high-quality, professional care to every client with or without tips because your wellness and experience are always our top priority*

I acknowledge that as a mobile concierge practice, SyxPoint Medical team members may request access to a restroom and a clean area to wash or sanitize their hands when clinically appropriate. This helps us maintain the highest standards of hygiene, safety, and professional care during your appointment.*

I acknowledge that SyxPoint Medical will send required intake paperwork and a secure link to complete your Good Faith Exam prior to your appointment. Clients are encouraged to complete all steps in advance so your visit can be focused on relaxation and care. Our team may contact you with friendly reminders if any items remain incomplete before your scheduled service.*

SyxPoint Medical will cover the cost of the initial Good Faith Exam for all new clients. Any required annual renewal exams after the first year will be the responsibility of the client and must be completed to maintain eligibility for services.*

I acknowledge that during the Good Faith Exam, I will be asked a series of health and screening questions related to all services offered by SyxPoint Medical. This comprehensive review helps ensure safe, appropriate, and personalized care for IV therapy, vitamin injections, and aesthetic treatments.*