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SELF-SCREENING FOR COLON HYDROTHERAPY

CONTRAINDICATIONS

(current conditions):

ANAL FISSURE (acute, painful crack or tear)
ANAL FISTULA (infected anal fissure)
ANEURYSM, ABDOMINAL
BOWEL IMPACTION
CHRON’S DISEASE
COLON CANCER
COLON, RECTAL, OR ABDOMINAL SURGERY
(Less than 6 mo. ago)
COLOSTOMY
DIVERTICULITIS
DYSENTERY
GASTROENTERITIS (food poisoning)
HEMORRHOIDS (Now painful or bleeding)
HERNIA, UNREPAIRED (Abdominal or Inguinal)
KIDNEY DIALYSIS
PREGNANCY (Current, and until 6 weeks post partum)
RECTAL BLEEDING (Current)
ULCERATIVE COLITIS

IF YOU MUST CURRENTLY ANSWER YES TO ANY OF THE ABOVE, PLEASE HAVE YOUR COLONIC SESSION AT ANOTHER TIME.

NEED PHYSICIAN'S WRITTEN REFERRAL

(for current conditions or treatments):

ANTI-COAGULANTS
CHEMOTHERAPY
COLITIS
DIVERTICULOSIS
SEVERE DEBILITATION OR TERMINAL ILLNESS

PRE-COLON HYDROTHERAPY PREPARATION

To request an appointment online use this form or to make appointments by phone,
call A.R.E.'s Health & Rejuvenation Center at (757) 437-7202.