Treatment Contraindications: Do you have the following?
> Known sensitivity to cold such as Cold Urticaria or Raynaud’s Disease
Yes
No
> I have been diagnosed with Cryoglobulinemia or Paroxysmal Cold Hemoglobinuria
Yes
No
> Impaired Peripheral Circulation in arms/legs (Avoid Area)
Yes
No
> Neuropathic Disorders such as Diabetic Neuropathy or Post-Herpetic Neuralgia
Yes
No
> Heart Damage, Disease, or Disorders
Yes
No
> Circulatory Disease/Disorders, High Blood Pressure, or Hemorrhagic Disease
Yes
No
> Deep Vein Thrombosis, Phlebitis, Moderate to Severe Varicose Veins
Yes
No
> I have been diagnosed with Hypercholesterolemia or Hypertriglyceridemia
Yes
No
> Poor blood clotting or current use of blood thinners
Yes
No
> Kidney Damage, Diseases, or Disorders
Yes
No
> Liver Damage, Diseases, or Disorders
Yes
No
> Lymphatic System Damage, Disease, or Disorders
Yes
No
> Skin Conditions- Eczema, Psoriasis, Dermatitis, Rosacea, or Rashes (Avoid Area)
Yes
No
> Numbness or Impaired Skin Sensation to Heat or Cold
Yes
No
> Acute or Chronic Inflammatory Processes (Avoid Area)
Yes
No
> Abnormal Immune System, Immunodeficiency, or Lupus
Yes
No
> Cancer (All Forms) (Doctor’s Release if diagnosis is under 3 years)
Yes
No
> Actively Undergoing Chemotherapy or Immune Therapy
Yes
No
> I have been diagnosed with HIV/AIDS
Yes
No
> Recent surgery or scar tissue in the area to be treated (Wait 6 Months)
Yes
No
> Open or Infected Wounds (Avoid Area)
Yes
No
> A Hernia, History of Hernia, or Diastasis Recti in the area to be treated
Yes
No
> Active implanted medical devices such as a Pacemaker or Defibrillator
Yes
No
> Medical Implants such as Mesh, Plastic/Metal Parts, or Screws (Avoid Area)
Yes
No
> Prosthesis, Silicone Implants, or Irremovable Piercings (Avoid Area)
Yes
No
> Facial Treatments- Botox or PDO Threads (Wait 3 Months); Derma Fillers (Wait 2 wks)
Yes
No
> Attempting to become Pregnant, Actively Pregnant, or Breastfeeding
Yes
No
> Active Menstrual Period (Wait until after cycle)
Yes
No
Pictures may be obtained for clinical records. If pictures are used for education or marketing purposes, all names and identifying marks will be cropped or removed.
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