PEMF Informed Consent Form | Epona Therapies

PEMF Therapy Consent Form

PULSED ELECTROMAGNETIC CELLULAR EXERCISER INFORMED CONSENT FOR DEMO AND/OR SESSION

By using and/or purchasing the Pulsed Electromagnetic Field (PEMF) Cellular Exercise system (the “System”) from Pulse PEMF, as the case may be (“PULSE”), the undersigned confirms that he or she meets the standards set forth below and agrees to the terms set forth below and the Standard Terms and Conditions on the reverse side of this sheet.

This acceptance includes an obligation to arbitrate all claims and disputes as provided herein, including any claims for injury, and a submission to jurisdiction as set forth herein. This is a binding legal obligation.

The system is designed for the purpose of cellular exercise to promote and support a sense of well-being. All uses of the System will be only to serve those purposes.

Do not use if:

● User has an implanted electronic device including a pacemaker, defibrillator, cochlear hearing device, spinal stimulator, etc.

● User is pregnant

● User is actively bleeding or hemorrhaging

● Human or Animal User have injuries or concerns of injuries that have not yet been evaluated by a licensed healthcare provider or Veterinarian

● Animal User has colic (consult a practicing veterinarian to decide whether it is appropriate to proceed)

If you are unsure whether pulsed electromagnetic field cellular exercise is right for you, consult your licensed health care provider(s).

Before beginning a PEMF Exercise Session we recommend the following:

● Remove the following from your person: Electronic or battery-operated devices, keys, wallets, cards with magnetic strips such as credit cards and hotel keys, jewelry, and hearing aids.

● Regarding metal implants, they can be a sensitive area; therefore, we recommend pulsing at a level where you feel comfortable.

During a PEMF Exercise Session:

● If the User experiences natural reactions that include but are not limited to nausea, headache, fatigue, muscle soreness, increase in menstrual flow, or any uncomfortable sensations, we recommend you suspend the session and consult your licensed health care provider(s).

● Animal Users may experience muscle soreness, stiffness, changes in fecal output, hives or skin changes, and mood/behavioral changes, and should seek Veterinary attention accordingly.

First Name

Last Name

Phone

Birthday

The undersigned agrees to the terms and conditions set forth in this document. I have carefully read this document and fully understand its contents I AM AWARE THAT THIS IS A CONTRACT BETWEEN MYSELF, PULSE AND EPONA SPORTHORSE THERAPIES AND CONTAINS AN ASSUMPTION OF RISK AND A RELEASE OF LIABILITY FOR MYSELF AND MY PROPERTY, INCLUDING ANIMAL USERS, AND I SIGN IT OF MY OWN FREE WILL. By checking the box and selecting continue I agree and am signing this release, I certify that I am eighteen (18) years of age or older or have delivered the consent of my parent(s) or guardian to PULSE and Epona SportHorse Therapies.

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