Optimal Life Vessel results require drinking one gallon (16 cups / 128 oz.) of water daily starting the day before your first Life Vessel session and for the subsequent 14 days.
Fathers Deceased Age
Fathers Health Issues
Mothers Deceased Age
Mothers Health Issues
(1)Siblings Deceased Age
(1)Siblings Health Issues
(2)Siblings Deceased Age
(2)Siblings Health Issues
Is your home environment stressful?
Are you in fear regarding your health?
Do you practice meditation or relaxation techniques?
Do you adhere to a particular diet?
Do you wear contact lenses?
Do you drink more than one alcoholic beverage a day?
Do you smoke?
Do you use recreational drugs?
---ReadySomewhat readyNot looking to make changes
I have read the above information and have completed this form to the best of my knowledge. I understand that the questions on this form are being asked in order to better assess my current condition and their relationship to my well-being. I further understand that I am voluntarily agreeing to have a relaxation therapy session in the Life Vessel and that no medical claims or promises of healing have been given. Lastly, I acknowledge that the Life Vessel treatments do not supersede the recommendation of my personal physician nor are intended to replace the conventional standard of medical care.
Payment is required for all services at the time they are rendered unless you are in a prepaid plan in which we participate. Although some of our services may be covered through your insurance plan, we do not bill your insurance and reimbursement is the responsibility of the patient. We are pleased to provide billing codes and any other documentation that will assist you through this process. We accept payment in the form of cash, check or credit card. If you must cancel or reschedule an appointment, please do so at least 24 hours before the scheduled appointment time. Your signature below signifies your understanding and willingness to comply with these policies.