Colon Hydrotherapy Questionnaire 

Consent for Treatment

I hereby request and contest to the performance of Colon Hydrotherapy treatments on me (or on the patient named, for whom I am legally responsible) by a licensed Colon Hydrotherapist who now, or in the future, treats me while employed by, working or associated with or serving as back-up for Sweet Waters Cleansing & Spa.

By checking the box below, I show that I understand the above consent to treatment, and have had an opportunity to ask questions. I intend this consent form to cover the entire course of treatment for my present condition and for any future conditions for which I seek treatment.

Thanks for submitting! See you soon!

Please select anything that is a health challenge.