Colon Hydrotherapy or ColoLAVAGE

Note: The first two forms are required.  The medical release form is only required if contraindications are present.

• Health Questionnaire - To be filled out at initial appointment
  
• ​Contraindications Questionnaire - To be filled out at initial appointment
  
• Medical Release Form (optional) - click here to download and print

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Intake Forms

All new clients of Gentle Waters need to download, print and complete intake paperwork prior to their initial appointment.

Links for Intake Forms for Colon Hydrotherapy or ColoLAVAGE services are found below.  

Paperwork for all other services will be completed in our office at the initial appointment.

(740) 392-3377

48 Public Square

Mount Vernon, OH 43050

Call (740) 392-3377

to schedule an appointment!!