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2024-06-21T14:51:02+00:00
iRelaxBot Customer Registration Form
Customer Information
Full Name
*
Date of Birth
*
Mobile Number
Height
Email Address
*
How did you hear about iRelaxBot?
Google
Groupon
Little Red Book
YouTube
Others
Please Specify:
If referred by someone, please provide the name(s):
Areas of your body you wish to improve:
If you have the following symptoms, please refrain from using iRelaxBot:
Severe heart disease
Severe primary hypertension
Severe malignant tumors (cancer)
Medical implants or stimulators (e.g. pacemaker or any medical device or major site of steel nail or steel plate)
Deep vein thrombosis
Alcohol influence
Epilepsy or mental disorders
Orthopedic surgery within 1 year
Bleeding or abdominal surgery within 1 year
Experiencing any bone injury
Spinal cord or brain has dominant lesion
Severe spinal deformity
Within 6 months after fracture surgery or unhealed after surgery
Within 6 months after cesarean section
Injection of hyaluronic acid within 3 months
Rhinoplasty within 3 months
Breast augmentation within 3 months
Eating within half an hour
Autologous fat filling within 3 months
Pregnancy or within 3 months postpartum
Loss of consciousness
Skin damage, ulcers, or bleeding
Under 6 years old
High fever
Severe osteoporosis
Infectious diseases
Perception impairment
Excessive sweating
Any other information we need to know:
I understand and accept that localized soreness may occur after effective therapy.
I promise I have read and completed this form seriously, and will inform the company promptly of any changes. I have been clearly informed and understand all the above taboos and promises that I do not have any of the above conditions. If I experience any discomfort during the treatment process, I will immediately inform the technician for appropriate adjustments. I agree to waive any liability on the technician and your company for any potential harm or damage caused by any untrue statements made by me regarding my health condition.
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