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Ionic Foot Detox Consent Waiver

Persons with low blood sugar should eat before using the Ionic Foot Detox.

Though not dangrous, persons having 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 blood stream, valuable electrolytes (calcium, potassium, sodium, and magnesium) may also be purged from the body. To safeguard against this possibility, users are encouraged to drink and Emergen C or have some minerals in water directly after their session.

 

Please intial that you have read the text above.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Please Check any of these boxes that are true to you.
I have a pacemaker or any other battery operated or electrical implant.
I am on heartbeat regulating medication.
I am pregnant or breastfeeding.
I have epilepsy.
I am a recipient of an organ transplant.
I am having an organ removed. (Particularly the colon)
I take medication. If I don't take this medication I would be mentally or physically incapacitated. (i.e: psychotic episodes or seizures, etc)
I have open wounds on my feet
I am currently undergoing chemotherapy or radiation.

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 and Ionic Foot Detox. You hereby agree to release The Primping Place from any liability or damage that may incur due to the use of the Ionic Foot Detox.


Click to customize date box label
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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