NanoVi™ Therapy Consent Form

NanoVi™ Therapy Consent Form

Patient & Provider Information

Introduction / Purpose

NanoVi™ therapy is designed to:

  • Support cellular repair and recovery

  • Reduce oxidative stress in cells

  • Promote healthy aging and wellness

  • Enhance physical and cognitive performance

Treatment Overview / How It Works

  • Patient breathes a biologically optimized, humidified air signal delivered by the NanoVi™ device

  • Sessions typically last 20–60 minutes, depending on protocol and goals

  • Frequency is determined by medical evaluation (commonly 1–5 sessions per week)

Contraindications & Warnings

NanoVi™ therapy may not be suitable for patients with:

  • Severe respiratory illnesses (e.g., COPD, asthma exacerbation)

  • Acute infectious diseases

  • Severe cardiovascular conditions

  • Sensitivity to humidified air or environmental factors

Precautions:

  • Ensure patient comfort and hydration during sessions

  • Monitor patients with respiratory devices or chronic conditions

Possible Risks / Side Effects

  • Mild: Temporary fatigue, mild dizziness, lightheadedness

  • Rare: Exacerbation of respiratory symptoms, short-term discomfort

  • NanoVi™ therapy is generally considered low-risk and non-invasive

Pre-Treatment Instructions

  • Avoid heavy meals immediately before the session

  • Avoid alcohol, nicotine, or caffeine prior to treatment

  • Wear comfortable clothing

  • Inform provider of all current medications, supplements, and health conditions

During Treatment

  • Patient remains seated and breathes normally into the device

  • Provider monitors comfort and progress

  • Sessions may include guided relaxation or breathing techniques

Post-Treatment / Aftercare

  • Hydrate adequately

  • Report any unusual symptoms immediately

  • Resume normal daily activities

Patient Responsibilities

  • Provide accurate health information

  • Follow pre- and post-treatment instructions

  • Notify provider of any side effects or changes in health

Acknowledgment & Consent

  • I understand the purpose, risks, benefits, and alternatives of NanoVi™ therapy

  • I voluntarily consent to undergo NanoVi™ therapy at AI Wellness Center of Excellence

  • I acknowledge that results may vary and no guarantees are made regarding outcomes

  • I release AI Wellness Center of Excellence, its providers, staff, and affiliates from liability, except in cases of gross negligence or willful misconduct

I consent to photographs, recordings, or data capture for medical documentation, education, or research if applicable