West Palm Beach, Florida In-Store Detox Disclaimer Step1_West Palm Beach_instore_DETOX First Name * Last Name * Location Do you have a pacemaker or any other electrical implant? Yes No If Yes, Due to manufacturers' recommendations, detox is not recommended. Have you ever had an organ transplant or removal? Yes No If Yes, Due to manufacturers' recommendations, detox is not recommended. Are you pregnant or breastfeeding? Yes No If Yes, Detox may temporarily remove important nutrients or vitamins; detox is not recommended. Do you take medication for heart disease? Yes No If Yes, a Detox may temporarily affect the effectiveness of some medications. Are you on any blood thinning medications? Yes No If Yes, Low-dose aspirin is considered safe for Detox. Are you currently undergoing chemotherapy treatment? Yes No Chemotherapy is contraindicated in Detox treatments. We welcome you back 6 months after treatment has ended and you have been cleared by your doctor Are you a hemophiliac (bleeding disorder)? Yes No If Yes, Due to manufacturers' recommendations, it may not be safe to do a Detox. ANY MAJOR HEALTH PROBLEMS? Yes No The Ionic Cleanse / Detox is not intended to treat, cure, prevent, or diagnose any disease or ailment. It assists your body to rebalance its bio-energy fields and stimulates the body for self-detoxification. It can help you to regain health and vitality. Many people report feeling more comfortable and having increased energy after only a few sessions. NOTICE: Garra services are not cosmetology services and are not designed to achieve any particular cosmetological effects/results. Garra is not a cosmetology salon, holds no state or other cosmetology licenses, and does not employ and state or other licensed cosmetologists. There is a weight restriction of 280 Lbs. for the safety of our guests due to the integrity of the tank/seat system. The Ionic Cleanse / Detox is not intended to treat, cure, prevent, or diagnose any disease or ailment. It assists your body to rebalance its bio-energy fields and stimulates the body for self-detoxification. It can help you to regain health and vitality. Many people report feeling more comfortable and having increased energy after only a few sessions. I certify that everything on this form is true and correct to the best of my knowledge. Signature * signature keyboard Clear How Many Children Are In Your Party ( For Guardian's Only )? * No ChildrenOne ChildTwo ChildrenThree ChildrenFour ChildrenFive Children Date signed * Please include your child/children's full name(s) for participation. Child 1: Child's Full Name * Child 2: Child's Full Name * Child 3: Child's Full Name * Child 4: Child's Full Name * Child 5: Child's Full Name * Submit
