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Exercise as Easy as Standing - My style for Life!

Health Risk Check List

In order to protect you from any possible injury, we at Style for Life want to make sure you do not have any of the following medical conditions before using our equipment.
Please review each question carefully and make sure you can answer a definite ‘‘no” to all the questions. If any answer is a yes or maybe, you must consult and receive permission from your physician before using our equipment.

Please note: We WILL NOT SHIP your Machine until this form is sent back to us with your signature.

1. Do you suffer acute joint problems such as arthrosis or acute rheumatoid arthritis?
2. Do you have acute inflammations or infections?
3. Are you an epileptic?
4. Do you have gallstones or kidney stones?
5. Do you have joint implants such as foot, knee and hip implants?
6. Do you suffer from serious cardiovascular disease?
7. Do you have heart valve disorders / heartbeat irregularities?
8. Do you have metallic or synthetic implants such as a pacemaker or IUD?
9. Did you have a recent thrombosis or possible thrombotic disorders?
10. Do you have serious back problems such as a herniated disk, discopathy,
spondylolysis?
11. Do you have any tumors?
12. Do you have recent (operative) wounds?
13. Do you have recent inflammations?
14. Are you pregnant or considering becoming pregnant?
15. Do you suffer from intense migraines?

By using our equipment, you agree that you have been advised and fully informed
concerning vibration technology sufficiently notified of all the risks associated with Whole
Body Vibration. You hereby relieve and hold Style For Life, Inc., your trainer, and all affiliates
harmless from all liability for injury or damage that may occur to you.

You further warrant:

(1) You have read, understand and fully agree to the foregoing consent,

(2) the proposed vibration technology session has been satisfactorily explained to you and you have read all the information you desire and

(3) You have fully disclosed any potential medical contraindications and are not now pregnant or trying to become pregnant, (4) You declare, having read this page that you can give a definite NO to all the above questions listed above.

By entering my name below, I agree to the above statement:

Enter full name here: ____________________                           Date:___/___/_____

All information gathered in this form will remain private and secure in compliance with
the HIPPA privacy rule. We will not share, disseminate, publish or otherwise make
public this information unless requested by you in writing.

Please e mail this form to info@mystyleforlife.com

Or fax to 888.851.1666

 

My Style for Life total Body Vibration Machine

What makes us diffferent
We don't just take your money and ship a machine, we want to help you stay fit for life! Our trained coaches keep you focused and motivated!

Our coaches

  • walk you through the steps to wellness
  • hold your hand,
  • keep you focused
  • motivated to stay healthy
  • educate and entertain you
  • hold you accountable
Discover the Style for life difference today s

 

 


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Health Risk Check List

In order to protect you from any possible injury, we at Style for Life want to make sure you do not have any of the following medical conditions before using our equipment.
Please review each question carefully and make sure you can answer a definite ‘‘no” to all the questions. If any answer is a yes or maybe, you must consult and receive permission from your physician before using our equipment.

Please note: By ordering our equipment, you agree that you have been advised and fully informed concerning vibration technology sufficiently notified of all the risks associated with Whole Body Vibration. You hereby relieve and hold Style For Life, Inc., your trainer, and all affiliates
harmless from all liability for injury or damage that may occur to you.

We whole heartedly believe in the powerful benefits of vibration therapy, however - vibration exercise is NOT for everyone. Please asnwer these questions truthfully and find out if you can benefit form a style for life vibration exercise machine.

1. Do you suffer acute joint problems such as arthrosis or acute rheumatoid arthritis?
2. Do you have acute inflammations or infections?
3. Are you an epileptic?
4. Do you have gallstones or kidney stones?
5. Do you have joint implants such as foot, knee and hip implants?
6. Do you suffer from serious cardiovascular disease?
7. Do you have heart valve disorders / heartbeat irregularities?
8. Do you have metallic or synthetic implants such as a pacemaker or IUD?
9. Did you have a recent thrombosis or possible thrombotic disorders?
10. Do you have serious back problems such as a herniated disk, discopathy,
spondylolysis?
11. Do you have any tumors?
12. Do you have recent (operative) wounds?
13. Do you have recent inflammations?
14. Are you pregnant or considering becoming pregnant?
15. Do you suffer from intense migraines?

PLEASE NOTE:

By ordering our equipment, you agree that you have been advised and fully informed
concerning vibration technology sufficiently notified of all the risks associated with Whole
Body Vibration. You hereby relieve and hold Style For Life, Inc., your trainer, and all affiliates
harmless from all liability for injury or damage that may occur to you.

If you have any questions at all please contact your physician or give us a call at 1 888 328 1488

You further warrant:

(1) You have read, understand and fully agree to the foregoing consent,

(2) the proposed vibration technology session has been satisfactorily explained to you and you have read all the information you desire.

(3) You have fully disclosed any potential medical contraindications and are not now pregnant or trying to become pregnant,

(4) You declare, having read this page that you can give a definite NO to all the above questions listed above.

By ordering the equipment you agree to the above statement:

All information gathered in this form will remain private and secure in compliance with
the HIPPA privacy rule. We will not share, disseminate, publish or otherwise make
public this information unless requested by you in writing.

Continue to place your order

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