PEMF Session Consent & Waiver

I request a PEMF session using the Pulsed Electromagnetic Field Cellular Exercise system (the “System”) provided by 2ND WIND ENERGY LLC dba 2ND WIND PULSE (the “Company”). This form explains the System, safety requirements, risks, my consent, and the terms that apply to my participation. The System is offered to support general wellness and the body’s natural abilities.

About the System

The System produces electromagnetic field energy that passes through human tissue. The FDA has not evaluated the System. It is not a medical device and is not intended to diagnose, treat, cure, or prevent any disease or medical condition. It is not FDA approved to treat or cure any disease or condition. I understand the System is described as experimental. No one has promised a treatment, cure, or specific result. Statements based on personal experience are for discussion and education only and are not guarantees or medical advice.

PEMF Safety Screening

Do not use the System if any item below applies. Answer each question honestly. If you are unsure whether PEMF is appropriate for you, consult your licensed healthcare provider before participating. The operator may decline or stop a session for safety.

Do NOT use if:

● User has an implanted electronic device including but not limited to a pacemaker, defibrillator, cochlear hearing device, spinal stimulator, glucose monitor, or insulin pump

● User has an implanted magnetic device including those deemed “unsafe for MRI” and those manufactured from ferromagnetic materials

● User is pregnant

● User is actively bleeding or hemorrhaging outside of normal menstrual bleeding

● User has blood clots and has not been cleared by a physician

● User is the recipient of an organ transplant

● User has injuries or concerns of injuries that have not yet been evaluated by a licensed healthcare provider.

Before and During a Session

Tell the operator about metal implants, recent surgery, medical concerns, or implanted items. Metal implants may be sensitive to electromagnetic stimulation and may require lower intensity.

Before the session, remove metal, electronic, and battery-operated devices, keys, wallets, magnetic-strip cards such as credit cards and hotel keys, jewelry, and hearing aids. Keep car keys with intelligent chips away from the treatment area.

Tell the operator about any discomfort. Stop the session and consult a licensed healthcare provider if you experience nausea, headache, fatigue, muscle soreness, increased menstrual flow, or another uncomfortable or unexpected sensation.

Follow the System’s written instructions and the operator’s safety directions. The operator may adjust or stop the session. I will not take actions that endanger my health or safety or another person’s health or safety.

PEMF Consent and Acknowledgment

I confirm that I have answered the safety screening accurately and disclosed relevant health concerns or implanted devices.

I understand that the System is for general wellness, is not a substitute for medical diagnosis or treatment, and has not been evaluated by the FDA.

I have had the opportunity to ask questions. I may stop the session and withdraw my consent at any time.

I understand that known and unknown risks may be associated with a PEMF session, including discomfort or reactions that cannot be anticipated.

I voluntarily consent to the session and agree to follow the safety requirements in this form.

PEMF Assumption of Risk and Release

I understand that I am using a magnetic pulse generator and voluntarily assume the risks and consequences of my participation. I release, indemnify, hold harmless, and agree to defend 2nd Wind Energy LLC dba 2nd Wind Pulse and its officers, directors, agents, employees, partners, members, affiliated companies, successors and assigns, and the manufacturer, and their employees or agents (the “Released Parties”) from claims, losses, or liabilities arising from or related to my use of the System, except to the extent a claim arises from gross negligence or willful misconduct. If medical treatment becomes necessary, including in an emergency, I release the Released Parties from claims arising from first aid, treatment, or medical services, including the lack or timing of such services, to the extent permitted by law.

To the extent permitted by law, 2nd Wind Energy dba 2nd Wind Pulse will not be liable for injury, loss of profits, revenue, or data, or for indirect, incidental, special, or consequential damages arising out of or in connection with the Pulse PEMF System. All damages will be limited to the price paid for the PEMF service. No one has promised that the System will treat or cure a disease or produce a particular result.

PEMF Terms of Use and Dispute Resolution

I agree to use the PEMF Pulse System only as described in written materials approved by the Company and to comply with applicable restrictions and policies. I will not rely on oral statements from a demonstrator as medical advice or as a promise of results. The opportunity to experience the System is consideration for my agreement to these terms. The Company may ask me to sign additional documents related to these terms.

This agreement is governed by California law, without regard to conflict-of-law rules. The parties may mutually agree to attempt good-faith mediation. If a dispute related to this agreement or services provided by the Company, including a claim for injury, is not resolved through mediation or negotiation within five business days after written notice, it will be resolved by one arbitrator under the JAMS Streamlined Arbitration Rules and Procedures in Los Angeles County, California. The arbitration will be administered by JAMS, and the arbitrator may decide their own jurisdiction, including the scope and enforceability of this agreement.

Either party may bring an individual claim in Los Angeles County Small Claims Court if the claim is within that court’s jurisdiction and does not involve injunctive relief or class-wide claims. Each party will bear its own attorney fees and costs associated with arbitration or a legal proceeding unless applicable law requires otherwise. Any arbitration award is final and binding. The parties will treat the award as confidential unless disclosure is required by law. State and federal courts located in Los Angeles County may be used to enforce an arbitration decision or award.

I agree to keep the terms of this agreement confidential except to the extent authorized by the Company or its authorized representative. If a portion of this agreement is found invalid or unenforceable, the remaining terms will remain in effect to the extent permitted by law.

I have read and agree to the dispute-resolution terms above, including arbitration. 

Chiropractic Consent & Waiver

Purpose of Chiropractic Treatment

The purpose of visiting a chiropractor is to address musculoskeletal issues and promote overall wellness through non-invasive manual adjustments. Chiropractors specialize in diagnosing and treating disorders of the musculoskeletal system, particularly those affecting the spine, joints, and nervous system. By employing techniques such as spinal manipulation, they aim to alleviate pain, restore mobility, and enhance the body’s natural ability to heal itself.

Chiropractic Services Provided by Rosales Chiropractic, A Professional Corporation

• Orthopedic Diagnostic Procedures

• Chiropractic Therapies and Physical Medicine Therapies

• General Diagnostic Procedures: including but not limited to venipuncture, pap smears, radiography, blood and urine labwork, general physical exams, neurological and musculoskeletal assessments.

• Minor office procedures: dressing a wound, ear cleansing, psychological counseling/lifestyle counseling, and exercise programs for lifestyle changes.

• Herbs/Natural Medicines: prescribing of various therapeutic substances including plants, shells, minerals, animal materials and other sources. Substances may contain alcohol, or raw herbs to be cooked; topical creams, pastes, plasters, washes, suppositories or other forms. Homeopathic remedies, often highly dilute quantities of naturally occurring substances, may also be used. Any substances that have been recommended are considered safe when taken as instructed in the practice of naturopathic medicine. It is extremely important that one follow the prescribed recommendations when taking herbs and nutritional supplements because they may be toxic when taken in large doses. In the US herbs are generally considered to be nutritional substances only. If we recommend or provide “herbal medicine,” what you are receiving is not considered “medicine” by US laws and we cannot and do not make any claims to be able to cure or treat any diseases or conditions with herbs or any other modality that we offer. Nor do we make claims about medicinal properties of herbs we may recommend. We are offering nutritional support for your condition only. In addition, we research companies we recommend and do our best to only use those we feel have high quality standards. However, we do not have control in the manufacture of supplements and herbs and as a precondition to us offering you advice regarding herbs or other nutritional substances, or to us compounding herbal formulas for you, you agree to not hold Rosales Chiropractic, A Professional Corporation or their affiliated doctors liable for any manufacture quality control issues.

• Dietary Advice and Therapeutic Nutrition: use of foods, diet plans or nutritional supplements for treatment—may include intramuscular vitamin injections or IV therapy.

• Soft Tissue and Osseous Manipulation: use of massage, neuro-muscular techniques, muscle energy stretching or visceral manipulation, as well as manipulations of the extremities and spine including traction and craniosacral therapy.

Assumption of Risk

We assume you are under the care of a licensed medical physician, MD or DO, in your area. We are not your primary health care provider. We are providing an adjunct service that is intended to complement your primary physician. If you are not currently under the care or supervision of a licensed medical doctor in your area, we highly recommend you do so, as the scope of our service is limited to treatment with natural substances and adjunct consultation. If you choose not to be under the care or supervision of a licensed medical doctor in your area, or if you follow our recommendations and they are in conflict with your physician or generally accepted medical principles, you do so completely at your own risk.

Jurisdiction

The laws of the State of California, excluding its conflict of laws rules, govern this agreement and your use of our service. If any portion of this agreement is found to be invalid, it will not affect the remainder of the agreement which is to remain in force. If any provision of this agreement is ruled to be illegal or unenforceable, the remaining terms shall continue to be in full force; and the illegal or unenforceable terms shall be modified to be as close as possible to the intention of the original terms and within the bounds of the law.

Acknowledgment

I understand that I may ask questions regarding my treatment before signing this form and that I am free to withdraw my consent and to discontinue participation in these procedures at any time. With this knowledge, I voluntarily consent to the above procedures, realizing that Rosales Chiropractic, A Professional Corporation and their affiliated doctors have given no guarantees to me. I understand that a record will be kept of the health services provided to me. This record will be kept confidential and will not be released to others unless so directed by me, my representative, or me or otherwise permitted or required by law. I understand that I have the right to review my record and obtain a copy of my record upon request and that obtaining a copy of my record may require payment of a fee.

I understand and am informed that in the practice of pain management, chiropractic or physical medicine there are some risks to treatment, including, but not limited to, fractures, disc injuries, strokes, dislocations, and sprains. I do not expect the doctor to be able to anticipate and explain all risks and complications, and I wish to rely on the doctor to exercise judgment during the course of the procedure which the doctor feels is in my best interest.

Participant Agreement to Both Companies

I have carefully read this form and understand it is a contract with 2ND WIND ENERGY LLC dba 2ND WIND PULSE and ROSALES CHIROPRACTIC, A PROFESSIONAL CORPORATION. It includes an assumption of risk, a release of liability, and an agreement to arbitrate certain disputes. I sign voluntarily.