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The Hive Ozone

Ozone consultation Form

Please complete this form as accurately as possible. Providing detailed and truthful information ensures we can safely tailor your Ozone Therapy to your specific health needs and goals. If you are unsure about any section, please ask a member of our team for guidance.

Contraindications to MAH Ozone Therapy

Ozone Therapy is NOT recommended if you have any of the following. Please tick any that apply:

Medical History

Tick any that apply:
Do you have any allergies?
Do you have a history of fainting?
Have you previously received IV Ozone Therapy?

What is your primary reason(s) for seeking MAH ozone therapy: (Check all that apply)

Tick all that apply:

Pre-Treatment Assessment

Tick any that apply:
Any abnormal results?

What is MAH Ozone Therapy?

Major Autohemotherapy (MAH) is a wellness therapy in which a small amount of blood is drawn up in to an I-set, a blood thinner either heparin or sodium citrate is added and mixed with medical-grade ozone,then returned to the bloodstream. Please note that Heperin may be derived from pork so please inform us if you have an allergy or are unable to use this.

 

It is believed to:

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  • Support immune function and Increase Oxygen Efficiency

  • Reduce inflammation and oxidative stress

  • Improve energy levels and  enhance circulation

  • Support the body’s natural detoxification

  • Antimicrobial Effects

POSSIBLE SIDE EFFECTS

Common Mild Side Effects:

 

  • Mild headache or dizziness.

  • Herxheimer reaction – Flu like symptoms often temporary and related to oxidative stress

  • Local irritation at the injection site such as redness, bruising, or discomfort.


Less Common but Possible Side Effects:

 

  • Low blood pressure or light headedness due to vasodilation effects of ozone.

  • Temporary increase in pain or inflammation due to a response to immune activation cell breakdown (homolysis)

  • Dark or Red Urine due to either detoxification or increased oxidative stress


Rare but Serious Risks:

 

  • Air embolism – If ozone is improperly administered into a vein in gas form

  • Oxidative stress overload if antioxidant reserves are depleted, leading to excessive oxidative damage.

  • Electrolyte imbalances if detoxification is too rapid.

Client Acknowledgment & Legal Disclaimer

By signing this form, I acknowledge and agree that:

 

  1. I am choosing to undergo MAH Ozone Therapy voluntarily and understand that this is a complementary wellness service,  not a medical treatment.

  2. I understand that this therapy is NOT intended to diagnose, treat, or cure any disease and does not replace medical advice or treatment from a licensed healthcare provider.

  3. I have fully disclosed my medical history, medications, and conditions.

  4. I understand that while ozone therapy has been widely used for wellness purposes, it is not FDA-approved for specific medical conditions.

  5. There are no guaranteed results, and individual responses vary.

  6. I have been given the opportunity to ask questions and satisfied with the explanations provided.

  7. I assume full responsibility for my choice to receive MAH Ozone Therapy and release The Hive Ozone from liability, except in cases of gross negligence or misconduct.

 

Consent for Treatment​

Thanks for submitting!

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