give permission for the Teal Center to take notes about me, including health history/medical and/or personal information I choose to disclose. I understand that this information will be kept strictly confidential.
I confirm that I have none of the following conditions, which are contraindicated for PEMF Therapy:
➢ I am not pregnant
➢ I do not have epilepsy
➢ I do not have an implanted electronic device, such as a pacemaker or insulin pump.
I agree to remove metal objects, such as my cell phone, and jewelry during the session.
I also understand:
➢ That PEMF Therapy is not considered a medical treatment and is not a substitute for medical examination or diagnosis and that it is recommended that I see a physician for any physical ailment that I might have.
➢ That, by providing PEMF Therapy, the Teal Center:
⮚ does not diagnose illness, disease or any other physical or mental disorder;
⮚ does not prescribe medical treatment or pharmaceuticals; and
⮚ does not perform any spinal manipulations.
I agree that any and all appointment times are reserved exclusively for me and that I am responsible to remember them and to pay for appointments that I miss, cancel, or reschedule with less than 24 hours notice.
If I need to reschedule due to illness or Covid exposure, I agree to contact the Teal Center as soon as possible. I authorize The Teal Center to charge my credit card on file for 50% of the full amount of any appointment missed, canceled, or rescheduled with less than 24 hours notice.