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Foot Detox Form

Date of Birth
Month
Day
Year
Have you ever had a Detox Foot session before?
Yes
No
Do you consume:

Contraindications:


Foot Baths are not suitable for everyone. If you have any of the following conditions, we recommend that you do not use the ion spa. If you have any other concerns regarding the use of the spa for health reasons, we recommend that you consult your doctor.

Do you wear a pulse adjuster, pace maker, metal or other electromagnetism device?
Yes
No
Have you undergone heart transplantation?
Yes
No
Do you have hypertension?
Yes
No
Do you have open wounds on your feet?
Yes
No
Are you a blood cancer patient?
Yes
No
Are you suffering from fever?
Yes
No
Have you been diagnosed with a serious illness?
Yes
No
Women only: Are you pregnant?
Yes
No

I, the undersigned, consent to the Detox Therapy Foot Bath Treatment. I understand that these procedures are for the purpose of detoxification and are not intended to take the place of medical care or medications. I clearly confirm that I do not have any contraindications to the Detox Therapy Foot Bath (as noted above). I understand that I take full responsibility for my own health and well-being.

Date
Month
Day
Year
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