Medical Indications for Use of Colon Hydrotherapy
Contraindications for Use of Colon Hydrotherapy
Have you had any of the following in the past 6 months?
(Please note: If you answer yes to any of the answers below- please see your doctor. Colonics can not be prescribed at this time.)
Please check all that you're currently experiencing:
Colon Hydrotherapy Rx Requirements
Rx maintained on file for 6 months.
I acknowledge I have been advised that all sales are final, but can be exchanged for other services or gifted. Any appointment not cancelled within 24 hours of the appointment will be charged for the services scheduled. I also understand a credit card is required to make/ hold any appointment slot. Once Doctor has already written your Rx, if you cancel at any time, a $50 fee will be charged to credit card on file to cover the Rx and processing fees, and awaiting you to reschedule.
Detoxity Spa reserves the right to refuse service to anyone. I agree that if I engage in rude or inappropriate speech or actions that my session will be cancelled and not refunded.
Form is complete- Please hit the submit button to send this form to Detoxity.