Online Forms

Fuse IV provides copies of our intake form(s) online for new Nutritional IV Therapy guests. Available as a downloadable PDF, you may fill out your intake form at your convenience before your first visit with us.

If you have not scheduled your initial appointment yet, please call 309.693.9600 prior to filling out the form.

New Fuse IV Guest Printable Forms

To download and print your intake form, please follow these steps:

  • If AdobeReader® is not yet installed on your computer, download it first.
  • Using AdobeReader or AdobeAcrobat, you can download forms, print them out and fill-in the required information.
  • Forms you can download include:

Email us your completed forms, or, you can simply bring it with to your first appointment.

Medical Forms & Records

If you have medical records that are pertinent to your initial visit or follow-up visits, you are responsible for obtaining them prior to that appointment. Your Medical Records can only be authorized for release by you. Please contact your physician or other health care provider to order these records.

Request an Appointment