True Rife Request 
The primary function of Rife is to clear infections from the body. For a more targeted and specific Rife treatment program, we strongly encourage doing at least one visit with one of our health practitioners to help assess your body's current condition and priorities. The questions below help us evaluate if you are a good candidate for Rife treatments and how we can best assist you on your healing journey.
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Date *
MM
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DD
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YYYY
Name *
Email *
Phone Number *
Age *
Have you ever had Rife treatments before? *
What is your main concern? *
Are you currently dealing with, or suspect, any infectious issues in your body? Please Check the box that applies to you.
 *
Required
Are you able to sit for periods of 30 minutes up to 1 hour?   *
What is your preferred length of treatment time?   *
Do you have a history of epilepsy? *
Do you have a pacemaker? *
Do you have any metal in your body (i.e. bone replacements)?   If Yes, please list all below. *
Are you pregnant or nursing? *
Are you sensitive to EMFs? *
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