Ala Carte IV

Ala Carte Menu

Please choose, combine, and select the ingredients you may want in your custom IV infusion.

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Please give accurate information so you are not confused with other patients

Date of Birth (d/m/y)

We respect your privacy. Your address will not be given to anyone without your permission. Please note that all correspondence will be via these addresses. Please be sure you can receive email from (there is no .com etc.)

We respect your privacy. BSI does not give personal information to outside parties. We request contact info in the event of schedule changes or emergency situations

Requested Day & Time

IMPORTANT, Please note: we will do our best to give you the requested time slot. Confirmation will be sent via WA or Email.

Important medical questions
Where would you like your appointment ?
Vitamin D

(Choose between MINERALS or EDTA) (Choose max 3 in this category)

EDTA / Chelation Therapy

(Choose between EDTA or MINERALS)

Medicines & Boosters
Amino Acids
Body Enhancement

(Choose max 2 in this category)

Homeopathic / Base Medicines

(Choose max 2 in this category – BSI Exclusive)

Brain Booster
Talk to Practitioner
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