215-340-3930

Well of Life Center for Holistic Healthcare

215-340-3930

Electro-Lymphatic New Client Paperwork

New Client Appointment Checklist

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Remove dentures
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No jewelry
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No makeup, perfume, lotions, or deodorants
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No shaving/waxing for 24 hrs prior to a session
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No food 2-4 hours prior to a session
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Complete and submit form below

These guidelines are in place for your protection and ours, as we strive to serve you to the best of our ability.

Please understand the importance of keeping your appointments. We do have a 24 hour cancellation policy that is strictly enforced.

Please contact our Client Advocate if you have any questions or need additional information.

Contraindications

You may NOT undergo Electro-Lymphatic if you have any of the following:
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An electronic device such as a pacemaker

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Have had surgery or an organ transplant, until consulting a physician to make sure the body has adapted to these altered changes
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Are on a blood thinner
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Currently pregnant

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Major cardiac problems
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On life support, has rods or pins, head coils, staples, or stunts
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Hemorrhaging or bleeding

New Client Form

CLIENT INFORMATION:

In Case of Emergency, please contact:

PERSONAL HEALTH & HISTORY:

Please understand that in answering questions, we do not diagnose or prescribe, but offer information only to help you cooperate with your doctor in your mutual problem of building health. In the event that you use this information without your doctor’s approval, you are prescribing for yourself which is your constitutional right, but the Well of Life Center for Holistic Healthcare, LLC through its clinicians, employees, and/or independent contractors collectively “Well of Life”) assume no responsibility.
By typing my name above, I authorize the Well of Life Center for Holistic Healthcare to perform the Electro Lymphatic Therapy session. I am doing this therapy, knowing that there are no guarantees, as none have been expressed or implied. Typing my name in the box acts as my signature on this page and absolves any liability on behalf any therapists of the Well of Life Center or any of their assigns, at this present time or any time in the future.

CONTRAINDICATIONS FOR ELECTRO-LYMPHATIC:

Please click HERE to read our Electro-Lymphatic Informed Consent and Liability Release Form and Agreement and Release of Liability. Then, sign by typing your full name in the box above. By signing, you are acknowledging that you have read and accept the terms and conditions of the Electro-Lymphatic Informed Consent and Liability Release Form and Agreement and Release of Liability.

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