Terms & Conditions

Consent form for the use of Ketamine with Oxytocin and/or Any other Controlled Substance.

The use of ANY Controlled Substance may cause addiction and is only one part of the treatment for Social Anxiety Disorder and/or Depression, PTSD, pain and Alcoholism.

Bliss Mist Rx will be used as medicine to improve my overall mental health including social anxiety, depression and/or PTSD, pain and alcoholism without causing any dangerous symptoms.

I agree to use my prescribed Bliss Mist Rx as prescribed and will not share my medicine with any other person.

I agree to inform my provider:

•  If I have used any other controlled substances, I’ve consumed either those prescribed or otherwise

•  If I have consumed alcohol or any other cannabinoid compound while using prescribed controlled substances

•  If I have been treated for side effects or complications related to the use of controlled substances related to the use of controlled substance, including if I have experienced an overdose

•  If there is any other state that I have previously resided in and/or had a prescription for a controlled substance filled

I agree to any additional monitoring of my drug use when deemed medically necessary by my provider

I understand that my provider may change or discontinue this controlled substance treatment as he/she deems best for my health

Consent for Treatment and Privacy Practices

I have requested medical service from Bliss Mist Rx on behalf of myself and understand that by making this request, I become fully financially responsible for all charges incurred during the treatment authorized.

I do hereby consent to necessary examination procedures and/or treatments prescribed by my physician, his assistants, or designee as is necessary in their judgement.

I understand the situations in which this practice may need to utilize or release my medical records.

I understand that this office will properly maintain my records and will use all due means to protect my privacy.

Financial Responsibility

All professional services rendered are charged to the patient and are due at the time of service.

Any medications will be an additional charge(s) and billed on a monthly subscription basis.

We accept all major credit cards for recurring monthly charges.

Email Permission Policy

I authorize Bliss Mist Rx to add me to their newsletter for merch drops, informational blogs and content, updates and more.

You agree that we will not be liable for failed, delayed, or misdirected delivery of any information sent through the Program, any errors in such information, and/or any action you may or may not take in reliance on the information or Service.

You may not use or engage with the Platform if you are under thirteen (13) years of age. If you use or engage with the Platform and are between the ages of thirteen (13) and eighteen (18) years of age, you must have your parent’s or legal guardian’s permission to do so. By using or engaging with the Platform, you acknowledge and agree that you are not under the age of thirteen (13) years, are between the ages of thirteen (13) and eighteen (18), and have your parent’s or legal guardian’s permission to use or engage with the Platform, or are of adult age in your jurisdiction. By using or engaging with the Platform, you also acknowledge and agree that you are permitted by your jurisdiction’s Applicable Law to use and/or engage with the Platform.