Schedule An Appointment "*" indicates required fields 1Select A Location2Select A Package3Patient Age4Patient Details5Select Appointment Time Raider Rehab Location*Please tell us the location closest to you.SelectLubbockMidland IV Packages*Please select your desired IV package from the list below. Hi-C $299 MEGA Myers $299 Myers Cocktail $239 Prenatal Bag $229 All American Migraine $179 Pick Me Up $179 Cold & Flu $169 Hangover Cure $145 Power Hour $109 B12 Injection $45 Tri-Immune Booster $65 Would you like to add additional items to your IV package?You may select one or more. The Raider Rehab team will let you know if any changes should be made based on your selections. These items are optional. B-12 Injection $20 Benadryl $20 Fluid $50 Glutathione $30 IV Tylenol $60 Magnesium Sulfate $40 Phenergan $35 Reglan $25 Stomach Bag Mini $50 Toradol $20 Tri-Immune Boost $50 Vitamin C $25 Vita-plex $45 Zinc $25 Zofran $20 Pepcid $25 The Tri-Immune Booster is only available at our Lubbock location. Please select another package.Unfortunately, Phenegran cannot be given with Reglan. Please update your add-on selections. Is the individual receiving the IV service at least 18 years of age?* Yes No Unfortunately, we are only able to provide mobile IV services to individuals that are at least 18 years of age. We apologize for any inconvenience. Legal Name*Please provide your name as it appears on your government issued photo identification. First Middle Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Where Should Your Mobile IV Service Be Performed?* The address above I would like to specify a different address Street Address For IV Service* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email Address* Medical History*Please check the appropriate conditions based on your current medical history. Type 1 Diabetes Type 2 Diabetes Congestive Heart Failure None of the items above Do you currently take diabetes drugs that are GLP-1 agonists such as Dulaglutide (Trucility), Exenatide extended dose (Bydueron bcise, Exenatide (Byetta), Semaglutide (Ozempic, Rybelsus), Liraglutide (Victoza, Saxenda), Lixisenatide (Adlyxin)?* Yes No Which GLP-1 medication?* Special NoteIf you have a note or special request regarding your IV package that you would like to pass along to the Raider Rehab Team, please let us know! Appointment Time*Please use our calendar to find instant availability for your appointment. Then, click on Schedule Appointment. Appointment Time*Please use our calendar to find instant availability for your appointment. Then, click on Schedule Appointment. Your selected appointment time will be automatically released after 10 minutes until you click on Schedule My Appointment.EmailThis field is for validation purposes and should be left unchanged.
