DETOX IONIC FOOT-BATH

INTAKE AND WAVIER

Advance Detox Center

7365 Carnelian Street, Suite 204

Rancho Cucamonga, Ca. 91730

909-989-1144

info@detoxwithcolonics.com

Do you have a heart pacemaker or any other battery operated or electrical implant?
Are you pregnant or breastfeeding?
Are you on medications to prevent rejection of a transplanted organ?
Are you on blood-thinning medication such as coumadin?
Do you take medication for irregular heart beat?
Are you on mental health medications?
Are you on blood pressure medication?
Do you have a seizure disorder?
Have you had any portion of your colon removed?
Have you been diagnosed with multiple sclerosis (MS)?
Are you taking prescription steroids or antibiotics?
Are you currently receiving chemotherapy treatments?
Are you taking Blood Pressure medication?
Are you hypoglycemic?
Do you have allergies or sensitivities?
Do you have any medical conditions that we should know about?

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