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Please download and complete the above form prior to your first treatment. You can complete either the Word (doc) version or the PDF. The PDF is a fillable form and can be completed on your device. You can then submit the PDF via email to mandy@gentlecolonhydrotherapy.com. If you want to print it and bring the completed form to your first visit, you can use either version depending on your own personal preference. It is recommended that clients complete the form prior to their appointment. If you forget the form, you will need to complete it at the office prior to your treatment.
Before booking, please read the list of contraindications to be sure colon hydrotherapy is right for you. If you are not sure, please call us at (916) 206-5507 to clarify. Some contraindications are temporary, for example, swollen or inflamed hemorrhoids. Therefore, call us if you’re not sure.
***IF YOU ARE RECEIVING TREATMENT FOR YOUR KIDNEYS (DIALYSIS), OR YOU HAVE ONLY ONE FUNCTIONING KIDNEY, WE CANNOT PERFORM COLON HYDROTHERAPY ON YOU.***
The following are contraindications for colon hydrotherapy. If any of these apply to you we are not able to treat you with colon hydrotherapy at the present time, unless you have a written prescription from an MD showing supervision over our services for the contraindication.
Contraindications for Colon Hydrotherapy
• Cancer of the colon or GI (gastrointestinal) tract
• Acute abdominal pain (please call us to clarify)
• Recent history of GI or rectal bleeding
• Congestive heart failure
• Uncontrolled hypertension
• History of seizures
• Carcinoma of the rectum
• Abdominal surgery (within 12 weeks of treatment)
• Intestinal perforation
• Abdominal hernia
• Recent colon or rectal surgery
• Diverticulitis
• Recent heart attack
• General debilitation
• Vascular aneurysm
• Renal insufficiency
• Epilepsy or psychoses
• Severe hemorrhoids
• Cirrhosis
• Fissures or fistula
• Pregnancy (in first and last trimesters)
• Ulcerative colitis
• Acute Crohn’s disease
• Rectal or abdominal tumors
3117 Dwight Road, Suite 200, Elk Grove, California 95758, United States
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