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Informed Consent

We believe you should be informed about your therapy decisions and fully comprehend what consent to.  Please fill out our Agreement Form, Consent Form, Acknowledgement Form and the Cancellation and Refund Policy.

Client Infomation and Consent

About ECP (External Counter Pulsation)

External Counter Pulsation (ECP) is administered using a technology that inflates (with air) and deflates three pairs of cuffs (similar to large blood pressure cuffs). The cuffs are wrapped around the legs and buttocks and are timed with your heartbeat. The cuffs inflate when the heart is resting and deflate when the heart is pumping. The special pumping cycle sends blood back to your heart at the time when it normally gets its blood, increasing the supply and decreasing the amount of work the heart must do to send blood through the body.


Consent:  I hereby give consent to Tenpenny Health Restoration Center (THRC) to perform ECP Therapy.

I understand and acknowledge no warranties, assurances or guarantees of successful therapeutic outcome have been made to me. I desire to undergo ECP after having considered the information in this document. Information has been given to me from this document and other educational materials provided by THRC and its staff.

To the fullest extent permitted by applicable law, signees and participants will hold harmless and indemnify THRC against any and all claims and actions arising out of participating in ECP therapy and the participants waives any/all rights, claims, and causes of action against THRC and its staff, administration and executives from claims, suits, or actions for liability or damages, that may occur from my participation in this activity and from any further or future health related issues I may experience. I voluntarily accept all risk associated with ECP therapy and I enter this agreement to receive therapy of my own free will and at my request. THRC has no responsibility nor burden of liability in the event of loss or harm.

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