By my signature below I understand that this facility uses FDA approved Colon Hydrotherapy Devices. To date no studies have been conducted for this alternative and complementary modality. I am aware adverse events such as perforation, injury and illness have been alleged and claimed with the use of colon hydrtherapy services and enema kits. Should I experience discomfort or pain, I am responsible for immediately stopping my session.
I have reviewed and discussed the contraindications listed above with the medical staff and I do not have any adverse health concerns and I wish to proceed with my colon hydrotherapy session(s).
The ansers I have provided are true, accurate and complete to the best of my knowledge.