Terms and conditions for THREE - 30 Minute MIGUN BED
MIGUN THERAPY™ INFORMED CONSENT
If you have any of the following conditions, please inform us prior to your Migun Therapy™ as you may be required to consult your physician for clearance prior to use, or you may not be a candidate for Migun Therapy™. Your safety is our primary concern. Check the box for any conditions which may apply:
□ Fused discs or implanted spinal/scoliosis rods or any other spinal hardware or implants that react to heat or which cannot tolerate pressure from massage.
□ Fractures or suspected fractures, or other traumatic injuries that have not healed
□ Malignant tumors or currently receiving cancer treatment
□ Are currently pregnant
□ Reactive skin disorders such as prickly heat rash or photoallergic dermatitis
□ Surgery within the past six months
□ Severe osteoporosis
□ Pacemaker, ICD
□ Acute disease or pain
□ Perception disorder
□ High Fever
□ Artificial organs or skeletons
□ Phlebitis/blood clots
□ Weight over 350 pounds
I understand that the Migun® Physiotherapy table and Migun Therapy™ is an FDA-cleared Class II medical device and therapy treatment that may provide positive change in chronic pain and other conditions. While generally considered a safe modality, there are potential side effects or adverse effects that I may experience, including but not limited to possible muscle soreness, bruising or tender spots, reactions to the heat therapy such as red spots or rashes (do not place Migun® handheld devices directly on the skin, we have provided towels for barriers to protect your skin), dizziness upon rising from the therapy table, nausea, skin eruptions (pimples, boils, etc.), digestive changes (diarrhea), flu-like symptoms from detoxification, headache, tingling, and tiredness.
I have carefully read this Informed Consent, understand it, and either do not have any of the conditions referenced above and/or have received clearance from a doctor to proceed with this therapy and/or have made an informed decision to assume the risk(s) and receive the therapies anyway because I believe the potential benefits outweigh the potential risks and wish to receive therapy using a Migun™ device.
I have been provided the opportunity to review the informed consent and question the use of the device(s), potential benefits, side effects, adverse effects, and contraindications which were discussed with me, and I have been provided an opportunity to address any questions or concerns in advance, during my treatment and have been advised that I may also discuss the therapy afterward in person, via telephone or email should I have any questions or concerns. I have been informed that should I require assistance getting on/off treatment tables/devices, I must bring someone with me to assist getting on and off the Migun Therapy Table as S p a c e t i m e F l o a t a t i o n C e n t e r staff may not be trained in proper lifting/transfer techniques and are unable to assist me with these maneuvers for my safety and theirs. As with all medical therapies, it is important to have an open dialogue with your primary care physician regarding your health. Migun users often need medication changes as they begin to see changes in their health.
Please consult with your physician as needed.
If you have any of the following conditions, please inform us prior to your Migun Therapy™ as you may be required to consult your physician for clearance prior to use, or you may not be a candidate for Migun Therapy™. Your safety is our primary concern. Check the box for any conditions which may apply:
□ Fused discs or implanted spinal/scoliosis rods or any other spinal hardware or implants that react to heat or which cannot tolerate pressure from massage.
□ Fractures or suspected fractures, or other traumatic injuries that have not healed
□ Malignant tumors or currently receiving cancer treatment
□ Are currently pregnant
□ Reactive skin disorders such as prickly heat rash or photoallergic dermatitis
□ Surgery within the past six months
□ Severe osteoporosis
□ Pacemaker, ICD
□ Acute disease or pain
□ Perception disorder
□ High Fever
□ Artificial organs or skeletons
□ Phlebitis/blood clots
□ Weight over 350 pounds
I understand that the Migun® Physiotherapy table and Migun Therapy™ is an FDA-cleared Class II medical device and therapy treatment that may provide positive change in chronic pain and other conditions. While generally considered a safe modality, there are potential side effects or adverse effects that I may experience, including but not limited to possible muscle soreness, bruising or tender spots, reactions to the heat therapy such as red spots or rashes (do not place Migun® handheld devices directly on the skin, we have provided towels for barriers to protect your skin), dizziness upon rising from the therapy table, nausea, skin eruptions (pimples, boils, etc.), digestive changes (diarrhea), flu-like symptoms from detoxification, headache, tingling, and tiredness.
I have carefully read this Informed Consent, understand it, and either do not have any of the conditions referenced above and/or have received clearance from a doctor to proceed with this therapy and/or have made an informed decision to assume the risk(s) and receive the therapies anyway because I believe the potential benefits outweigh the potential risks and wish to receive therapy using a Migun™ device.
I have been provided the opportunity to review the informed consent and question the use of the device(s), potential benefits, side effects, adverse effects, and contraindications which were discussed with me, and I have been provided an opportunity to address any questions or concerns in advance, during my treatment and have been advised that I may also discuss the therapy afterward in person, via telephone or email should I have any questions or concerns. I have been informed that should I require assistance getting on/off treatment tables/devices, I must bring someone with me to assist getting on and off the Migun Therapy Table as S p a c e t i m e F l o a t a t i o n C e n t e r staff may not be trained in proper lifting/transfer techniques and are unable to assist me with these maneuvers for my safety and theirs. As with all medical therapies, it is important to have an open dialogue with your primary care physician regarding your health. Migun users often need medication changes as they begin to see changes in their health.
Please consult with your physician as needed.