Intake Form Health & Physical

Please take a moment to complete this form

Your health is top priority to us. Please complete the form and let us know if you have any questions. Be sure to coordinate your care back with your primary care physician and medical team. For emergency situation, please dial 911.

Step 1 of 3

Personal Information

Please check if you have any of the following contraindications
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For any other questions, contact us at:
(855) 954-7843


Liquid Mobile IV Located in Optima Biltmore Towers
4808 North 24th Street, Suite 125,
Phoenix, Arizona 85016

Liquid Mobile IV Located in Chiefs Fit Overland Park
9290 Metcalf Ave.
Overland Park, KS 66212

Liquid Mobile IV Located in Chiefs Fit Plaza
612 W 47th St.
Kansas City, MO 64112