Ionic Foot Detox-Phiyahfit

Ionic Foot Detox

Please fill out this form as best you can so we can provide you with the most relevant and safe service. YOU MUST USE YOUR SAME EMAIL YOU SIGNED UP WITH.

I UNDERSTAND I ONLY NEED TO FILL OUT THIS INTAKE EVERY 6 MONTHS (please DON'T FILL THIS OUT AGAIN, if you did within 6 months)

I give my permission to receive ionic detox soak. I understand that ionic detox is not a substitute for traditional medical treatment or medications. I understand that the therapist does not diagnose illnesses or injuries, or prescribe medications. I have clearance from my physician to receive an ionic foot detox. I understand that partaking in ionic foot detox is voluntary and there can be risks involved such as feeling tired or even getting sick due to toxins releasing. I understand that it is my responsibility to inform my therapist of any discomfort I may feel during the session so he/she may adjust accordingly. I understand I can ask any questions before the detox session begins. I fully release the Healing Room, Phiyahfit and its practioners and therapists from any LIABILITY. I assume all risks.

I UNDERSTAND the above liability waiver terms.

Your Signature that you understand and release any liability.

First Name

Last Name

Phone Number

Choose 1 or more: Why are you interested in getting a Detox Foot Soak?

I feel tired and exhausted often

I have been eating poor

I have been drinking a lot

I have been smoking too much

Do you have any medical conditions at all? Please list

I am agreeing to subscribe to the Healing Room mailing list.