Ion Cleanse Foot Bath Release Form

Who cannot have a foot bath?

Patients CANNOT have a foot bath if they:

• Have taken any medications within 2 hours of foot bath appointment

• Are pregnant or breastfeeding

• Have a pacemaker

• Medication to prevent rejection of a transplanted organ

• Blood thinners

• Medications for an irregular heartbeat

• Pill Form Chemotherapy – (see criteria below for Drip Form Chemo)

Who has to meet certian criteria to have a foot bath?

• Electrical implants - can only have a foot bath if they can safely shut the

electrical device off.

• Mental health medications – those who can safely skip a dose of their

medication can take a foot bath. (Dr. can approve)

• Blood pressure medications taken twice a day - can safely have a foot

bath.

• Blood pressure medications taken once a day - they must take the

medication only AFTER the foot bath.

• Drip Form Chemotherapy - it has to be at least 3 days since the last

treatment to safely have a foot bath.

• Hypoglycemia - recommended to eat 30 minutes before foot bath.

• Diabetic - recommended to eat 30 minutes before foot bath.

By signing below, you agree you have read and understood the above criteria.