Consent to Ionic Foot Detox Consent to Ionic Foot Detox Please Read each and Click/Check that you fully understand. Client Name * First Last Name * Last Email * Phone Address Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Am I currently pregnant and/or nursing? * No Yes I have a pacemaker or any other battery-operated electrical implant. * No Yes I am currently taking heartbeat medication. * No Yes I have epilepsy. * No Yes I am the recipient of an organ transplant. * No Yes I am having an organ removed. (Particularly the colon). * No Yes I take medication. If I don't take this medication, I would be mentally or physically incapacitated. (Examples: psychotic episodes or seizures, etc.) * No Yes I have open wounds on my feet. * No Yes I am currently undergoing chemotherapy or radiation. * No Yes * If I experience any pain or discomfort during the session, I will immediately inform the provider so that the products and/or technique may be adjusted to my level of comfort. * I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session. * Acknowledgement: I understand and acknowledge that payments for the above services are non-refundable. By my signature below, I certify that I have read and understand the contents of this Consent Form. * ***I further agree to provide a 24 hour cancellation notice or change of appointment time, or will forfeit a treatment off my package since treatments are by appointment only. There are not refunds on package sessions since they are highly discounted, if decide to stop treatments. Should I decide to add a treatment, that treatment will be considered an additional and separate treatment. * Persons should not wear metal, use a computer or cellular phone during the Ionic Foot Detox session. * Persons with low blood sugar should eat before using the Ionic Foot Detox session. * Persons should not wear metal, use a computer or cellular phone during the Ionic Foot Detox session. * Though not dangerous, persons having a metal joint implant may find exposure to the electromagnetic field generated by the Ionic Foot Detox to be uncomfortable. If discomfort is experienced, the session will be stopped immediately. * Persons taking prescription medication should take meds after or four hours prior to their session. * Because the Ionic Foot Detox is designed to aid the body in eliminating toxins that the kidney and liver cannot eliminate on their own, as a general rule, it may be used by persons on dialysis or by those diagnosed with diabetes or congestive heart failure. However, persons with these conditions, or any other medical condition, should consult their physician prior to implementing the Ionic Foot Detox as part of their wellness program. * In addition to toxins being pulled out of the bloodstream, valuable electrolytes (calcium, potassium, sodium, and magnesium) may be also be purged from the body. To safeguard against this possibility, users are encouraged to drink water directly after your session. Disclaimer: * We do not make any claim to offer cures or treatment of any disease or illness. If you are sick, please consult with your doctor. Acknowledgement: * By signing below, you acknowledge that you have read and understand this document, and have received acceptable answers to all of your questions and consent to receiving an Ionic Foot Detox. You hereby agree to release Shape It Up Contouring from any liability or damage that may incur due to the use of the BioCleanse Ionic Foot Detox. Client Signature * signature keyboard Clear Submit If you are human, leave this field blank. Δ