Informed Consent for PEMF Therapy

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I hereby request a QRS 101 PEMF session. I understand that the QRS 101 System creates a fully adjustable pulsed magnetic field. I understand that the information shared by the demonstrator are his/her personal opinions and are intended for educational purposes only.  

Product Disclaimer 

Pulsed electromagnetic field (PEMF) therapy is FDA-approved to fuse bones and has been cleared in certain devices to reduce swelling and joint pain. The QRS 101 PEMF System produces magnetic field energy, which passes freely through tissue for the purpose of cellular exercise to promote and support a sense of wellbeing. The FDA has not evaluated the QRS 101 System. It is not intended for the diagnosis, treatment or cure of any medical condition. The QRS 101 System is not a medical device and we cannot make any claims that we can affect medical conditions.  

We understand these general statements regarding pulsing magnetic fields to be accurate: “PEMF (pulsed electromagnetic field) devices do not treat a specific condition. Instead they optimize the body’s natural self-healing and self-regulating function.” -- Dr. Magda Havas Associate Professor of Environmental & Resource Studies at Trent University  “all atoms, chemicals and our body’s cells produce electromagnetic fields. We have seventy trillion cells in our body communicating with each other via electromagnetic frequencies. Any disruption in this electromagnetic energy impairs our body’s cells from functioning well, and left unchecked the cells voltage further deteriorates and our cells become unhealthy and we experience low energy, illness and disease. Ultimately every illness is the consequence of impaired cell voltage." --Dr. William Pawluk, MD, MSc.  

Contraindications

Do not use if: 

• you have an implanted or battery operated electronic device including: pacemaker, defibrillator, cochlear hearing device, spinal stimulator, etc. 
• you are pregnant 
• you are actively bleeding, hemorrhaging, or during heavy menstruation  

Before beginning a PEMF Session we recommend the following: 

• remove the following from your person: Electronic or battery operated devices, keys/fobs, wallets, ID and cards with magnetic strips such as credit cards and hotel keys, jewelry and hearing aids 
• HEAL Wellness Center and our technicians are not responsible for damage to technology that has not been removed prior to your session 
• If you are unsure whether PEMF is right for you, consult with your licensed health care provider(s)  

During a PEMF Session 

If you experience natural reactions that include but are not limited to nausea, headache, fatigue or any uncomfortable sensations, we recommend you suspend the session and consult your doctor.  

Beyond what is stated above, I understand that other risks associated with a PEMF Session are unforeseeable and that the demonstrator, the manufacturer, the marketer, employees, agents and affiliates cannot accept any liability for loss or damages incurred as the result of the QRS 101 System session. I reserve the right to use the knowledge I have gained in the care of my own body in any legal manner I may choose. I have read this form and voluntarily agreed to the PEMF session on my person assuming all liability for any and all results or consequences.