Brain Therapy Studio Release

BRAIN THERAPY STUDIO RELEASE:

I affirm that I am free from the following conditions if utilizing the Brian Therapy Studio Devices:

PEMF Therapy:

I certify that:

• I do not have an electric, magnetic or electromagnetic implant. (Examples; Pacemaker, Defibrillator, Brain or Spinal Chord stimulator, etc.) If I do, I certify that I have contacted the treating doctor and let them know that I will be using a PEMF device with a maximum average flux density of 150 microTesla and to be sure that this will not interfere with the function of the implantable device.
• I do not have any active medical implants that are intended to administer medication (medication pumps).
• I am not receiving immunosuppressive therapy in consequence of transplantation.
• I am not receiving immunosuppressive therapy in consequence of allogenic cellular transplantations or bone marrow stem cell transplantation. Other conditions often requiring immunosuppressive therapy, e.g. autoimmune diseases or dermatological diseases are not contraindications to the use of BEMER therapy. BEMER therapy application has to be cleared by physician in charge.

Audiovisual Entrainment: I certify that I am currently do not have epilepsy or seizure disorder and do not have sensitivity to flashing lights.

Red Light Therapy: I certify that I am not currently on medication or utilizing products that may induce photosensitivity.

Infrared and Red Light Sauna: I certify that I am not currently claustrophobic; I certify that I am not currently on medication or utilizing products that may induce photosensitivity; I am not currently taking any diuretics and agree to make sure I am properly hydrated prior and post sauna use.

Please type your name in the box below to sign:

Date:

I agree and voluntarily assume the risks of injury, accident, or death that may arise following my use of any of the aforementioned brain therapy studio devices. I and any of my heirs, executors, representatives, or assigns hereby release all claims or liabilities for personal injury or property damages of any kind sustained while on the premises during the use of the devices and from any advice provided by an employee or independent contractor of the Maryland Center for Brain Health. I agree that this application and waiver is in effect for all studio treatments and will not expire unless expressed in writing by either party: