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We are seeking a passionate and experienced Colon Hydrotherapist to join our team. Please contact us to learn more.

760-705-8387

Monday - Sunday 8am-7pm

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Colon Hydrotherapy Additive Waiver Form

Client Information

Name(Required)
MM slash DD slash YYYY

Additives and Allergies

By stating your name above, you authorize Flora Integrated Wellness to use of the following additives during my colon hydrotherapy session.
Check all that apply:
Allergy Disclosure
Do you have any allergies or sensitivities to the following?

Acknowledgment and Signature

Client Acknowledgement(Required)
- These additives are optional and not required for a successful colon hydrotherapy session.
- I have disclosed all medical conditions, allergies, or contraindications to my practitioner.
- Colon hydrotherapy and all additives are wellness services, not medical treatment or diagnosis.
- I release the practitioner and facility from any liability related to my voluntary use of these additives.
- I understand that I must notify my practitioner immediately if any of my medical conditions, allergies, or medications change, and I will complete a new form reflecting these updates.
Clear Signature
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Contact Us

Monday - Sunday 8am-7pm

760-705-8387

300 S. Escondido Blvd Suite 103 Escondido, CA 92025

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