PATIENT INFORMED USE DISCLAIMER & CONSENT FORM

This form is to be kept on file at any clinic or provider location offering EQ Flux Pro sessions. Providers are strongly advised to have all clients review and sign this form before their first session.

What to Know About EQ Flux Pro

• EQ Flux Pro is a Class I FDA-registered therapeutic device intended for general wellness, performance recovery, and physiological optimization.

• It is not approved to diagnose, treat, or cure any medical condition.

• The session involves low-frequency current NeuroPulse FIR + PEMF delivered via surface coils to the body.

Contraindications

• You should NOT receive EQ Pro therapy if you have:

• A pacemaker or implanted electronic device

• Metal implants that are heat-sensitive or reactive

• Active bleeding or hemorrhage

• Are pregnant

• Have an organ transplant or are immunosuppressed

• A condition not evaluated by a healthcare provider

Acknowledgements

☐ I have been informed of the intended use and limitations of EQ Flux Pro.

☐ I do not have any known contraindications.

☐ I understand this is not a substitute for medical diagnosis or treatment.

☐ I understand the session may cause temporary physical sensations such as warmth, tingling, or muscle relaxation.

Consent

I voluntarily consent to use the EQ Flux Pro device as part of a general wellness or recovery service. I understand the nature of the session and have had the opportunity to ask questions. I agree to come and stay hydrated for a minimum of 48hrs after my treatment.

I release the provider and EQ Pulse Wave, Inc. from liability for any adverse reactions resulting from improper disclosure of contraindications or unanticipated personal response.

Disclosure:

Affirm: For personal use. Terms apply.

Disclosure:

If one or more items in your order has an extended ship date, your loan payment(s), including interest, may be due before the merchant ships all of the items. Please note that you may not receive a rebate of any interest that may have already accrued on an amount that later gets refunded.

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