Human | SURGE Equine

Human PEMF Therapy Session Release Form

Full Name

Phone

Street Address

City

State

Zip code

Gender

Please specify anything we should know about

MagnaWave creates more cell permeability, thus medications and liniments may be absorbed more than intended.

I hereby state that I am at least 18 years of age and have read, understand and agree to this Release Statement, that it is an informed release and that I intend to be legally bound by it.

» I am not pregnant
» I have no pacemaker or other battery operated implanted stimulator
» I have not had an organ transplant
» I do not have any chains on me (jewelry is OK)
» I do not have any car key, credit card, cell phone or watch on me
» I agree to be fully responsible for any damages if I forget this
» I know that I am using a magnetic pulse generator that is not approved by the FDA to treat or cure any disease or condition
» I understand that this is an experimental device

No one has made any representations or claims to me of any treatment or cure of any disease or condition; or any promise of any specific or general results of any kind.

I release from all general, medical and any other liability or claims of any kind; and, I indemnify and hold harmless the MagnaWave magnetic pulse generator, the manufacturer, distributor, dealer and any of their employees or agents from any claim arising from or related to my use of the magnetic pulse generator

Enter full name as a forme of signature

Thanks, you are good to go!