2280 East Avenue, Suite 4, Rochester, New York 14610, United States

(585) 209-9109

(585) 209-9109

  • Home
  • Services
    • Colon Hydrotherapy
    • BioMat Therapy
    • Light and Sound Therapy
    • ColoLAVAGE
    • Deluxe Cleansing Combo
    • Food Intolerance Testing
  • Schedule Now
  • Intake Paperwork
  • Location and Hours
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  • About Us
  • More
    • Home
    • Services
      • Colon Hydrotherapy
      • BioMat Therapy
      • Light and Sound Therapy
      • ColoLAVAGE
      • Deluxe Cleansing Combo
      • Food Intolerance Testing
    • Schedule Now
    • Intake Paperwork
    • Location and Hours
    • Contact Us
    • About Us
  • Home
  • Services
  • Schedule Now
  • Intake Paperwork
  • Location and Hours
  • Contact Us
  • About Us

Gentle Pathways

Gentle PathwaysGentle PathwaysGentle Pathways

Colon Cleansing for Better Health

Colon Cleansing for Better HealthColon Cleansing for Better Health

Intake Paperwork

New clients must download and complete the intake paperwork for the requested service and bring it with you to your appointment.  All paperwork is found below.  


Existing clients: Please note that if you have not had an appointment for more than 3 years, you will need to download and complete new paperwork.

Colon Hydrotherapy Intake Forms

Contraindications Questionnaire (pdf)

Download

Colonic Intake Form (pdf)

Download

Medical Release Form (optional) (pdf)

Download

NOTE: The Medical Release form is only required when contraindications are present.

BioMat Therapy Intake Forms

BioMat Intake Form (pdf)

Download

                       The above file is the only required form for BioMat Therapy.

Light and Sound Therapy Intake Forms

Photon Sound Beam Intake Form (pdf)

Download

                 The above file is the only required form for Light and Sound Therapy.

ColoLavage Intake Forms

Contraindications Questionnaire (pdf)

Download

ColoLAVAGE Intake Form (pdf)

Download

ColoLAVAGE Consent Form (pdf)

Download

ColoLAVAGE Prescription Form (pdf)

Download

The prescription form needs to be completed by your GI doctors office.  The other forms are required for clients to complete.


Please contact our office (phone: 585-209-9109, email: info@gentle-pathways.com) for instructions on how to prepare for your ColoLAVAGE session and if you'd like assistance coordinating your ColoLAVAGE session with your GI doctors office. 

Deluxe Cleansing Combo Intake Forms

Deluxe Cleansing Combo Intake Form (pdf)

Download

      The above file is the only required form for the Deluxe Cleansing Combo Therapy.

Cancellation/No-Show Policy

We understand that everyone occasionally has something that prevents them from coming to their scheduled appointment. We recognize that your time is important and hope that you understand that our time is important too. We have a 24 hour cancellation policy so that if you find that you are unable to keep your appointment, we can offer your time slot to others. Missed appointments or canceling an appointment without 24 hours notice will result in a fee of up to 50% of the cost of the service. Please note that for new client appointments we do require a deposit to reserve your appointment time. We reserve the right to keep the deposit if you don't come for your appointment or fail to give sufficient notice when cancelling or rescheduling an appointment. If you cancel an appointment in which you paid a deposit and provide more than 24 hours notice, you can receive a refund for your deposit minus a 3% transaction fee. Deposits can be applied to a rescheduled appointment if at least 24 hours notice was provided asking to reschedule an appointment. You may use a different form of payment at the time of service for the remainder of the cost of the service. 


Please note: If a client has not yet arrived 15 minutes after the scheduled start time, it is assumed that the client is not coming and will incur a no show fee as described above.


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