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Intake Form

Ionic Foot Bath Cleanse

BASIC INFORMATION

Contraindications

Are you currently Pregnant?
Yes
No
Not Sure
Do you have a pace maker or electrical implant?
Yes
No
Not Sure
Have you had an organ transplant or are on immune repressive medication?
Yes
No
Not Sure
Are you in Active Chemotherapy treatment?
Yes
No
Not Sure

WAIVER

WHAT TO EXPECT


The body will continue to eliminate toxins after the foot bath is completed, making extra water intake essential. Tiredness may be experienced after the treatment, as the body needs a little time to recuperate after having toxins liberated from your system. Healthy individuals can expect to feel lighter and experience a greater sense of well being from each session.

Inquiring about nutritional supplements and/or lifestyle modifications can help to maximize the detoxification process and ensure optimal health goals are met.

 

I understand that Ionic Foot Bath therapy may have positive or negative side effects as a result of doing a session. I accept legal responsibility for my choice to do a this session and waive the responsibility of the practitioner and the facility where the session takes place in the case that any of the named side effects (or others) may occur.

 

Please type your full name below as your signature to confirm you understand all of the benifits this session will provide.

Date
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