PEMF Therapy Consent Form

PEMF Therapy Consent Form

Patient & Provider Information

Introduction / Purpose

Pulsed Electromagnetic Field (PEMF) Therapy is a non-invasive modality that uses low-frequency electromagnetic waves to:

  • Improve circulation and oxygenation at the cellular level

  • Reduce inflammation and promote tissue repair

  • Enhance recovery from musculoskeletal injuries or chronic pain

  • Support overall wellness, energy, and cellular function

Treatment Overview / How It Works

  • PEMF devices deliver electromagnetic pulses to targeted areas of the body

  • Sessions typically last 10–45 minutes, depending on treatment goals

  • Frequency, intensity, and duration are customized per patient needs

  • Treatment may be repeated multiple times per week or per recommended schedule

Contraindications & Warnings

PEMF Therapy may not be suitable for patients with:

  • Pacemakers, defibrillators, or other implanted electronic devices

  • Pregnancy or breastfeeding (unless cleared by a physician)

  • Active bleeding disorders or severe cardiovascular conditions without clearance

  • Epilepsy or seizure disorders without provider approval

Precautions:

  • Remove all metallic objects near the treatment area

  • Inform the provider of any implanted medical devices or electronic equipment

  • Avoid simultaneous treatments with unapproved modalities in the same area

Possible Risks / Side Effects

  • Mild: Tingling, warmth, or mild discomfort at the treatment site

  • Rare: Dizziness, nausea, or transient fatigue

  • Very rare: Exacerbation of existing conditions (if contraindications not disclosed)

Pre-Treatment Instructions

  • Wear comfortable clothing

  • Remove jewelry, watches, or metal accessories from treatment area

  • Stay hydrated and inform provider of any recent medical procedures or changes in health status

During Treatment

  • Patient will be positioned comfortably, and the PEMF device applied to target areas

  • Patients may feel mild pulsing or tingling; this is normal and indicates device is active

  • Provider will monitor for comfort and safety throughout the session

Post-Treatment / Aftercare

  • No downtime is required; patients may resume normal activities

  • Drink water to support cellular recovery and detoxification

  • Contact provider if experiencing unusual pain, dizziness, or any adverse effects

Patient Responsibilities

  • Provide accurate medical history and disclose all health conditions, devices, or medications

  • Follow pre- and post-treatment instructions provided by the clinic

  • Report any side effects or complications promptly

Acknowledgment & Consent

  • I understand the purpose, risks, benefits, and alternatives of PEMF Therapy

  • I voluntarily consent to undergo treatment 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