Pressotherapy Treatment Consent Form

I duly authorize MyEMSHealth (EMS Health LLC) to perform the pressotherapy treatment. I understand that pressotherapy is an approved technology which uses controlled pressure to stimulate the lymphatic and blood systems of which I hereby consent to be a client receiving the pressotherapy treatment. I confirm that I have informed the staff regarding any current physical condition and that I don't the following contraindications preventing me from receiving the treatment:
deep vein thrombosis, infections in the legs or in the areas to be treated, severe heart disease, wearing the pacemaker, physical pain or numbness, cancer. 
I also undertake to inform the staff of any changes to my medical condition prior to any further future treatments.I understand that there is a possibility of temporary Short-Term Effects which have been fully explained to me: Slight burning and itchy sensation due to the increase and stimulation of Lymph and Blood flow A headache can occur due to the elimination of toxins. I have been fully informed and understand: The nature and purpose of the treatments; Expected outcomes and possible short-term effects; The fee structure including the payment terms and conditionsThe late arrival, no-show and cancellation policies. The decision to proceed is based solely on my expressed desire to do so. Where applicable, I understand the importance of Before and After Photographs and consent to the following: The taking of my before and after photographs. I authorize their anonymous use for the purposes of education and promotion.I have read and fully understand the contents of this consent form.
Purpose of collecting and holding information: Any personal information gathered as part of your assessment and treatment process will be kept securely and, in the interests of your privacy, used only by your Consultant and the authorised personnel of the practice (as necessary).

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