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By visiting our office
you are attesting to the following Informed Consent:
I
understand and consent that I will not be receiving a medical diagnosis
or medical treatments at this facility. I am fully aware that the
director of this facility is a Traditional Naturopath, Certified Colon
Hydrotherapist, researcher and BioEnergetic Healer. She does not hold a
medical license, and that Georgia does not currently offer nor require
licensure for Naturopaths.
Any homeopathic remedies, supplements, or herbal products discussed
during my visits, sessions, seminars, or consultations are not
prescription drugs used to treat or cure a specific disease or illness
and are offered only as a convenience to me. I understand that the
product lines available at this facility are only offered through
professional healthcare practitioners so I may be unable to purchase the
identical products. However, I am always free to purchase equivalent
supplements at my local health food store, herb shop or online.
I
have been made aware that the BioEnergetic, colonic and detoxification
treatments have not been thoroughly studied, researched and proven to
treat or cure any disease, illness or condition. No guarantees or
promises have been made as to the outcome of my health status or the
amount of time it may take to reach my health and nutritional goals.
The Colon Hydrotherapy device used in this facility is a FDA Registered
Class I, non-medical / non-prescriptive gravity device. I understand
that Colon Hydrotherapy is a self-administered procedure where I, as the
user, am solely responsible for my own actions and release liability
regarding my health. I have the choice to make my colonic session
completely private but will have immediate access to my therapist at all
times. Furthermore, I accept the responsibility for self-insertion of
the rectal tube. Insertion of the rectal tube at this facility by a
therapist is strictly forbidden. I am aware that the professionals at
this facility aren’t physicians even though they may wear scrubs or lab
coats to protect clothing. Therefore, they do not insert, diagnose, or
prescribe. I am aware that adverse events and illness have been alleged
and claimed with the use of colon irrigation and enema devices. I agree
that if I experience any resistance during the insertion of the rectal
tube, I will stop immediately and notify my therapist. If I experience
excessive discomfort, cramping, pain, nausea or vomiting, I am
responsible for notifying my therapist and stopping my own session.
I
am aware that this facility does not accept insurance and expects
payment at the time services are rendered. Services may be reimbursable
under a Flexible Spending Account, Cafeteria Plan, or Health Savings
Accounts. You may want to check with your benefits administrator for
details and requirements. I understand there is a 24 hour cancellation
notice policy. Furthermore, that I will be charged $50 or the amount of
the scheduled service if it is less than $50, should I fail to provide
such notice. I understand these policies are subject to change without
further notice.
Further, I agree that I will not attempt to schedule appointments for
colon hydrotherapy unless or until I have a prescription on file from my
medical doctor, if I have been diagnosed with any potential
contraindications. Additionally, I will not schedule any footbath
appointments if I am pregnant, may be pregnant, or nursing, have a pace
maker, or other electronic implant device, or have a transplanted
organ.
This facility does not claim to cure or treat any condition or disease.
So please do not ask your therapist what is in your footbaths or in your
feces. Without formal testing and quantitative analysis one could only
speculate. Any lab tests, analysis or screenings done at our facility
are not traditional clinical or medical tests used for the sake of
diagnosis but rather are an evaluation of potential weakness or stress
areas to the body.
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