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Client Information

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Client Forms

Is this your first appointment? If so, please click here to fill out the appropriate intake form. This will help us get to know you and will save you some time during your first visit.

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    Application and Waiver

    Consent to use the Ozone Therapy LLC, dba Austin Ozone (collectively the “Company”) facilities is conditional upon provision of accurate answers to the following questions and signing the Waiver of Liability.

    Personal Info







    Emergency Contact

    Referral Source



    Medical Record






    Please list any Practitioners that you are currently seeing (conventional and/or alternative)


    Have you had or currently have any of the following?
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    Cautions:
    • Precautions are necessary for a safe ozonated steam sauna session. By signing this form, I agree that I will comply with all instructions on the use of this equipment in my own self-treatment.

    • If at any time during the use of the ozonated steam sauna session I experience pressure in the chest, dizziness, nausea, or coughing, I will discontinue the session by opening the doors of the steam sauna and exiting.

    • Since I understand that ozone can amplify the effects of drugs and supplements due to increased cellular absorption, I acknowledge that it may therefore be necessary to reduce dosages.

    • By signing this form, I freely state that I have not received any diagnosis or prescription by any employee or agent associated with the Company.

    I agree that the Company and its employees and agents, and the manufacturer of this equipment, are not liable for any injury to person or property caused in any way by the use of these services, premises or equipment. I agree that if I have not followed the pre-sauna requirements including eating and drinking water, I may be refused service, which would be considered an appointment cancelation.

    In consideration of the acceptance of the Application and Waiver, I hereby waive and release for myself and my heirs, executors and administrators any claims of any nature whatsoever which I might at any time have against the Company, its employees or its agents, or the manufacturer of the equipment; and do acknowledge that I will use the services provided at my own risk. I confirm that I have given accurate answers to the above questions, that I will carefully follow all directions given and that I am of legal age in this jurisdiction.

    Signature:

    Rectal Insufflation Instructions

    Before Usage
    Minimum requirement is a recent bowel movement within the last 2 hours. It is important to have the colon thoroughly cleansed first. A series of colonics or enemas with a qualified colon therapist is recommended. If the bowel is impacted with fecal material trapped within the folds of the intestines, the ozone can also get trapped. As a result the belly can becomes bloated, making the patient feel uncomfortable and possibly nauseous. This will pass and is only temporary.
    Application Instructions
    • Insert the catheter up to 4 inches into the rectum. It should be comfortable, do not force it.
    • Attach the outlet of the bag to the catheter. Remove clamp and start gently apply pressure to the bag with your hands. This is how you slowly push the ozone into your colon. Start with a small amount (200 ml) and slowly increase. Slowly squeeze bag. You want to slowly introduce the ozone into the rectum under very low pressure, which allows absorption through the portal vein of the rectum. Hold ozone in as long as possible. If cramping occurs, it is best to clamp off ozone and remove catheter. Let out the bowel movement in toilet and start again. The procedure should take a few minutes to complete.
    • Once the bag is empty, slowly remove the catheter
    • Place the catheter into the original catheter packaging
    • Finally, place the catheter into the sharps container on the wall
    Contraindications

    IMPORTANT!

    If you have any reason to believe your colon is weak and prone to rupture? Do not perform Rectal Insufflation!
    I confirm that I have read and will carefully follow the instructions given above. If at any point during the self administration of the rectal insufflation I feel uncomfortable, I will stop and contact an ozone specialist at the number below. I also confirm that I will use the rectal insufflation bag provided at my own risk.

      Signature:

      COVID Sanitizing Procedures