



NEED PHYSICIAN'S WRITTEN REFERRAL
(for current conditions or treatments):
ANTI-COAGULANTS
CHEMOTHERAPY
COLITIS
DIVERTICULOSIS
SEVERE DEBILITATION OR TERMINAL ILLNESS

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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
CROHN’S DISEASE
COLON CANCER
COLON, RECTAL, OR ABDOMINAL SURGERY
(Less than 6 mo. ago)
COLOSTOMY
DIVERTICULITIS (Unless you have NOT had
an episode in the last 6 months, and you ARE currently
symptom-free.)
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.
PRE-COLON
HYDROTHERAPYPREPARATION
CLICK HERE
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