Bodstim™ Client Treatment Consent, Waiver and Release

I acknowledge that bioelectric stimulation treatments and related biologics procedures, if any, are not an exact science and no specific guarantees can or have been made concerning the outcome related to both safety and efficacy.

I understand that some clients may experience more change and improvement than others. In virtually all cases, multiple treatments are required in order to realize a difference.

I also understand and agree to fully and undeniably assume the following risks and hazards which may occur in connection with any particular treatment including but not limited to: unsatisfactory results, soreness, poor healing, discomfort, redness, blistering, nerve damage, scarring, infection, and change in skin pigmentation, allergic reaction, muscle damage, and increased hair growth. I understand that even though precautions may be taken in my treatment, not all risks can be known in advance.

It's also important to note that studies have linked EMS to an increased risk of rhabdomyolysis (aka rhabdo), the damage or injury of muscles resulting in the release of muscle fiber contents into the blood, which can lead to serious complications such as kidney failure, according to the U.S. National Library of Medicine (NLM).

Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treatment received, I agree to unconditionally defend, hold harmless and release from any and all liability the company and the individual that provided my treatment, the insured, and any additional insureds, as well as any officers, directors, or employees of the above companies for any condition or result, known or unknown, that may arise as a consequence of any treatment that I receive.

I understand clearly and fully that the stimulation device and electrode suit being used in these procedures only has FDA 510K market clearance for these indications of use:

1. Augmenting muscle building from exercise.

I further understand that the above may not improve my muscle volume or strength.

I hereby strictly agree to only use the device 2X a week for no more than 15 to 20 minutes max of high intensity stimulation (greater than 5 milliamps) per session and no more than 1 hour total use time including warm up 5 minutes, cool down and relaxation mode non-contractile low intensity stimulation time of up to 40 minutes max.

I have read and fully understand the contraindications listed below and hereby agree and consent that I do not have these incompatibilities.

I understand the company, its employees, its advisors, board directors, suppliers and clinical collaborators in no way make any claim(s) that the device or methods have been proven safe or efficacious for the purposes of treating my condition.

I have fully disclosed on here below any medications, previous complications, or current conditions that may affect my treatment.

I understand and agree that any legal action of any kind related to any treatment I receive will be limited to binding arbitration using a single arbitrator agreed to by both parties.

Model, Photographs and Data Use Release

In consideration for treatment received, I hereby grant permission to the individual or company that provided my treatment to use any photographic treatment records for the purposes of clinical and statistical studies, advertising, or promotion without any additional compensation to me.

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Consult with your specialist before joining our training programs if you have any of these characteristics:

  • Circulatory disorders and problems
  • Abdominal or inguinal hernias
  • Neurologic disturbances
  • History of hemophilia or excessive bleeding tendency
  • Skin irritations, burns or wounds
  • Diseases that affect muscular metabolism (example: diabetes)
  • Metabolic syndrome ( diabetes, high blood pressure, obesity)
  • High levels of uric acid
  • Metabolic alterations or metabolic pathologies
  • Inflammatory pathologies or diseases


By accessing the Bodstim System, you acknowledge and agree that your performance of any and all exercises or activities recommended by the Bodstim System is wholly at your own risk. You acknowledge and agree that the Bodstim System is intended for use only by individuals healthy enough to perform strenuous exercise.

  1. a) You must not use the Bodstim System if any of the following are true:
  2. you have a pacemaker (artificial pacemaker), implanted defibrillator, or other implanted metallic or electronic device. Such use could cause electric shock, burns, electrical interference, or death.
  3. you are menstruating or pregnant;

iii. you are experiencing extreme muscle strain or trauma, or if you are experiencing a muscle strain condition such as rhabdomyolysis;

  1. you have been diagnosed with any heart problem or condition,
  2. you have an inadequate blood supply (ischemia) or a serious blood circulation disorder in the lower limbs;
  3. you have an abdominal or groin hernia;
  4. b) Before using the Bodstim System, we highly recommend you seek guidance from a qualified healthcare practitioner if you have any preexisting injuries or conditions that may interfere with recommended activities, or have any of the following:
  5. a tendency to bleed internally (hemorrhage) following trauma or fracture;
  6. acute trauma or a fracture or following recent surgery when muscle contraction may disrupt the healing process;

iii. been diagnosed with epilepsy or another neurological disorder;

  1. nerve damage resulting in a lack of feeling in a particular area of the body;
  2. a loss of muscle tissue or muscle atrophy, experience muscle spasms, or have muscles associated with painful or afflicted joints;
  3. persistent pain;

vii. required muscle rehabilitation; or

viii. suspicion of any heart condition,

List Any Medications or Pre-Existing Conditions Here and Sign and Date Below

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Signature Certificate
Document name: Bodstim™ Client Treatment Consent, Waiver and Release
lock iconUnique Document ID: 3ac08e096977a923d49f75e748b61d679227c2dd
Timestamp Audit
March 2, 2023 9:57 am PDTBodstim™ Client Treatment Consent, Waiver and Release Uploaded by Howard Leonhardt - IP