CONTRAINDICATIONS FORM
Patient Name
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First Name
Last Name
Today's Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Treatment Start Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
NIN
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Epilepsy
Have a Demand Type Cardiac Pacemaker
Rhabdomyolysis
Malignant Tumors
Undiagnosed Pain Syndromes
None Of The Above
MICRO CURRENT
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Cardiac Pacemaker
Implanted Medical Devices That Cannot Be Turned Off
Pregnancy or Birth
None Of The Above
WELLNESS PRO PLUS
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Cardiac Pacemaker and/or Implanted Defribillator
Pregnancy or Suspected Pregnancy
Implanted Medical and/or Electronic Devices
Metal Anywhere In The Body
Undiagnosed Pain Syndrome
None Of The Above
PIEZO WAVE
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Acute Infections
Tumor Tissue
Clotting Disorders Or Treatment With Blood Thinning Drugs
Pregnancy or Suspected Pregnancy
Pacemaker
Arterial Hypertension
Open Growth Plates
None Of The Above
MAGNESPHERE
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Implanted Electrical Stimulators In The Brain (Unless given permission by a Neurologist or Surgeon)
Chronic Atrial Fibrillation
Epilepsy
Congestive Heart Failure
High Blood Pressue
None Of The Above
LYMPHATIC
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Congestive Heart Failure (CHF)
Blood Clots
Pregnancy or Suspected Pregnancy
Stroke
Active Cancer
Undergoing Dialysis
Implanted Electrical Devices That CANNOT Be Turned Off
Currently Breastfeeding
None Of The Above
LYMPH Contra Is Within 6 Months Of
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SOT Therapy
CAR-T Therapy
Stem Cell Implant
None Of The Above
COLD LASER THERAPY (LASER)
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Cancerous, Precancerous or Suspected Cancerous Tissues
Immune Suppression Therapy
Pregnancy or Suspected Pregnancy
Epilepsy
None Of The Above
NEUROMUSCULAR RE-EDUCATION (NMR)
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Pregnancy Or Suspected Pregnancy
Active Blood Clots
Pacemaker Or ICD
None Of The Above
EST
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Pregnancy or Suspected Pregnancy
Blood Clotting Disorder
Cardiac Pacemaker
Epilepsy
Known Disturbance In Heart Rhythm
Surgery In The Last 6 Weeks
None Of The Above
IONIC FOOT DETOX (FDX)
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Pacemakers, Or Any Other Battery Operated Or Electrical Implant
Pregnancy, Suspected Pregnancy or Nursing Women
Heartbeat Regulating Medications and/or Blood Thinners
Nursing
Organ Transplant Recipient
On Medications In The Absence Of Which Would Cause Mental or Physical Impairment, Such As Psychotic Episodes, Seizures, Etc.
None Of The Above
TRANSCUTANEOUS NEUROMODULATION (TN/STIMPOD)
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Infection Off A Puncture Site
Known Neurologic Disorders
Severe Coagulation Disorders
Pacemaker
None Of The Above
PELVIC WAVE
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Pregnancy or Suspected Pregnancy
Battery-Operated Implanted Medical Devices Located Below The Sternum
History of Atrial Fibrillation
Endometriosis
None Of The Above
DECOMPRESSION
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Unresolved Compression Fractures On The Spine
Spondylolisthesis or Spondylolysis
Post-Surgical Conditions (Unstable)
Open Growth Plates
Severe Canal Stenosis
Surgical Hardware In The Spine
Rotators or Severe Scoliosis
Abdominal Aortic Aneurysm
Vertebral Fusions
Inflammatory, Infectious, or Neoplastic Conditions
Pacemaker
Spinal Instability Due To Genetic Defects or Structural Abnormalities
Some Annular Tears (Doctor's Precaution)
Osteoporosis
None Of The Above
CERESET
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Pregnancy or Suspected Pregnancy
Implanted Electrical Stimulators In The Brain
Implanted Medical Devices (If Cannot Be Turned Off)
Epilepsy Or Active Seizures
None Of The Above
OXYGEN CONTRAST THERAPY (OCT)
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Exercise Restriction From A Doctor
None Of The Above
FULL BODY DIAGNOSTIC SCAN
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Pregnancy or Lactation
Pacemaker
Epilepsy and/or Convulsive Syndrome
Dermatitis On The Palms Skin/Open Wounds On Hands
Acute Illness (Active Flu, Cold, COVID, Bronchitis, Strep Throat, Pneumonia, Etc)
Limb(s) Amputation
Implanted Electrical Devices That CANNOT Be Turned Off
Age Younger Than Five
Psychic Disorders: Must Be Able To Communicate and Be Mentally Competent
None Of The Above
X-RAYS
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Pregnancy or Suspected Pregnancy
None Of The Above
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