Consent for Undergoing Activated Oxygen Therapies

  • I,understand the recommendation of one or multiple intra-venous activated oxygen therapies for me. These therapies (Hydrogen Peroxide & Ozone), although discounted by conventional medicine and unapproved by insurance companies actually have a 50 year long track record of safety and efficacy. Under Dr. Shallenberger, Kim Renfro RN has taken continuing medical education workshops and seminars which emphasize and teach the safest and most optimal application of these therapies. She is certified in Ozone Therapy.

    I understand that these treatments enhance cellular oxygen utilization, blood flow, cellular healing, and pain relief. By way of protein-like molecules called cytokines these therapies stimulate immune system activity. I now that depending on the type and dose of activated oxygen therapy I receive, some effects will be more anti-inflammatory and anti-microbial, whereas others will promote cellular regeneration and immune modulation. All of these therapies, to the extent that they enhance tissue oxygenation and blood flow, relieve pain and inflammation, up-regulate antioxidant enzyme defenses, and stimulate immune function are beneficial for a broad constellation of medical conditions. I understand this research has been profusely documented in peer reviewed medical and scientific journals for decades and the therapy (ies) advocated are no way unproven, dangerous, or experimental when administered within the limits and standards of this training.

    I understand that should I currently be in any of the following conditions, one or more of these therapies may not be appropriated for me: Pregnancy, Thyrotoxicosis, Hemophilia, Porphyria (UV blood irradiation), acute disc herniation, extremely low platelet count, atopic dermatitis, photo-sensitivity, or photo-active medication. Also I understand that as with any intravenous therapy, I might experience transient hypoglycemic (low blood sugar) headache and/or light-headedness, local swelling, bruising or irritation at the catheter insertion site, a brief resetting of my menstrual cycle or slight hemolysis if I have a G6PD deficiency. Since the human body is not the same as a household appliance, I understand that no warranties or guarantees about these therapies with respect to my condition. I do, however, understand the broad application of these therapies to sub-optimal oxygenation states, which is the underlying abnormality in almost every chronic and refractory malady. I further acknowledge that it is my right to cease activated oxygenation therapy at any time. Finally, I understand that my insurance carrier will likely not pay for activated oxygen therapies in spite of their safety, cost (relative to patent medicines), and effectiveness.

    With full awareness of the above facts and considerations, I, Give my consent for giving me one or multiple of these oxygen therapies.


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