INFORMED CONSENT TO PURCHASE AND SELF ADMINISTER OXIDATIVE (OZONE) THERAPY

Through phone discussions or online consultation with Dr David Epstein, D.O. and Second Opinion Physician you may have been advised to consider non-blood ozone therapy.

Dr Epstein and Second Opinion Physician PC follows the “Madrid Declaration on Ozone Therapy” for the use of non-blood ozone therapies. The “Madrid Declaration on Ozone Therapy” is the first consensus document in the history of global ozone therapy. 26 ozone therapy national associated and international federations have signed the “Declaration of Madrid on Ozone therapy”. It stipulates the safe and effective use of ozone in intravenous therapy in clinical practice.

Benefits of oxidation therapy are believed to be strong modulation of the immune system, improvements of flow properties of blood, improvements in oxygen delivery and utilization, improvements to metabolism, improved defenses against infection, and improvement of many blood markers.

There is always some risk to any procedure, regardless of how rare. It is always possible to have allergic reactions to just about any medication, which, in a worst case scenario, can cause a life-threatening reaction. These therapies have never been reported to cause allergy, except in photosensitive patients, or those who take photosensitive drugs.

There are occasional herxheimer reactions (infectious organisms which die-off, and cause symptoms of detoxification). These can include self-limiting, mild to moderate flu like symptoms: fever, chills, pain, aching, headache, fatigue, lethargy, rashes and phlegm. We recommend the use of a binder such as activated charcoal or GI detox to help minimize these symptoms. Infusing ozone gas into any orifice can occasionally cause irritation to the soft tissue.

Oxidative therapies have not been approved by the FDA and are therefore considered experimental treatments. Because the use of Oxidative medicine is regarded as experimental, and because our practice is via telemedicine, we do not offer this procedure to you and advise seeking a provider or else purchasing your own properly designed device such as those offered on the Biotype Nutrients website. We only offer such devices on the condition you do release us from any legal responsibility for harm resulting from its use in your case, and your agreement will constitute a full and final release of our legal responsibility resulting from the recommendation or your purchase or use of oxidative therapies for your case or any other medical treatment, for which you may choose to use the ozone generator.

I have read and understand the above statement. I hereby acknowledge the therapy as a self administered device for the ozonation of drinking water specifically. For water ozonation or any other method of use that I choose to administer, based on available research and instruction provided by Second Opinion Physician and abundantly available on the Web.

I understand the possible risks of Ozone therapy, understand that any results are not guaranteed and give informed consent to receive treatment. I release Dr David Epstein D.O. and Second Opinion Physician, P.C. from any and all liability associated with the use of this equipment or recommendations provided via website videos, educational material, blog or telemedicine consultations.

I also acknowledge that Dr David Epstein D.O. and Second Opinion Physician, P.C have provided me with ample opportunity to ask questions and have received answers that are to my complete satisfaction.