York County PEMF LLC Equine Intake and Consent Form
Date
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Month
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Day
Year
Date
Horse's Name
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Horse's height in hands
Horse's Age
Your Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your horse is not a suitable candidate for PEMF if any of the below apply. Check every box to confirm the condition does NOT exist.
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My mare is NOT pregnant: Pregnant mares should avoid PEMF therapy as its effects on fetal development are not well understood.
My horse does NOT suffer from seizure disorders: Horses with a history of seizures or epilepsy should avoid PEMF therapy, as it could potentially trigger seizures and the research does not provide adequate information supporting its use in these cases.
My horse does NOT have an acute infection: PEMF therapy may not be suitable for horses with acute infections, as it could potentially worsen the condition by stimulating the immune system.
My horse is NOT colicing: PEMF should not be used if your horse has colic or is undergoing colic treatment.
My horse does NOT have any implated device: PEMF can interfere with some electrical medical implants, so you should consult your veterinarian before using PEMF on a horse with any implants. Microchips are not affected by PEMF.
Have your horse ever had PEMF therapy?
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Yes
No
If yes, for what?
Reason for seeking out PEMF for your horse. Please be as specific and detailed as possible and list any areas of concern.
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Horse's brief history of any surgeries, illnesses, or medical issues:
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Horse's Daily activities (work, exercise, wellness regimen):
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Detoxification
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Natural bodily responses of detoxification that may occur during and after an animal’s Pulse session may include coughing, sneezing, vomiting, diarrhea, light-to-moderate sweating, appearance of waxy skin or hair, coat purge and regrowth. Every animal responds differently, so it is important to keep your veterinarian informed as Pulse sessions progress.
Consent
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PULSE PEMF is not a medical device and is not approved by the FDA or NDF. It is not intended to diagnose, treat, cure, or prevent any medical condition. All information provided is for educational purposes only and should not replace professional medical advice. By choosing to use York County PEMF services, I acknowledge and accept all associated risks, including potential injury or worsening of existing conditions. I understand that I am responsible for ensuring that my horse is medically cleared by a licensed veterinarian and for informing staff of any health changes before each session. I also authorize York County PEMF to seek emergency medical care if needed and accept responsibility for any related costs. By proceeding, I release York County PEMF and its affiliates from any liability and confirm my voluntary participation. Please click to acknowledge.
Please click to acknowledge and sign below:
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I understand that these services are not a substitute for medical care, and any advice provided is for educational purposes only. I confirm that the information I’ve provided is accurate, that I am 18 years or older, and that I accept all risks associated with participating in these services. Please click to acknowledge.
Signature
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