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INFRARED SAUNA: ASSUMPTION OF RISK, WAIVER AND RELEASE FROM LIABILITY

The use of infrared saunas may have many health benefits; however, it is important that you fully understand how to use the sauna and gradually introduce your body to the infrared sauna therapy to produce the best results. In all situations, hydration is a requirement for sauna use. Drinking filtered water or even advanced electrolyte replacement water is recommended before and after sauna use.

Self-treatment of any disease with an infrared sauna is not recommended without direct supervision of a certified physician. If anything listed below applies to you, please consult your physician before using an infrared sauna.

 

** DO NOT USE the infrared sauna if you are Pregnant or have Hemophilia, Fever, or Heat Insensitivity. ** In the rare event that you experience dizziness, pain and/or discomfort, immediately discontinue sauna use.

 

WAIVER AND RELEASE OF LIABILITY: It is not advisable to use an infrared sauna under certain medical conditions and it is recommended that you consult a physician before first use or if questions/concerns arise. It is solely your responsibility to monitor your body/reactions and determine if it is appropriate to use the infrared sauna. You alone are responsible for your safety and well-being.

By signing,  I,  a  client  of  Salt Wellness Centre (Salt) hereby  release  Salt Wellness Centre (Salt) and  its  directors,  officers,  employees,  agents  and  professional  staff  from  all  actions,  causes  of  action,  suits,  claims,  liability,  damages  and  demands  of  any  kind  ,  whether  direct,  indirect,  special,  exemplary  or  consequential,  including  interest  thereon  (the  Claims) which  may  occur  as  a  result  of  any  injury  including  death  sustained  by  myself  or  others  resulting  from  the  use of the infrared sauna.

 

First Client Name

First Name*

Middle Name

Last Name*

Phone*
First Client Date of Birth*
First Client Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
First Client Signature*
Second Client Name

First Name*

Middle Name

Last Name*
Second Client Date of Birth*
Second Client Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
Third Client Name

First Name*

Middle Name

Last Name*
Third Client Date of Birth*
Third Client Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
Fourth Client Name

First Name*

Middle Name

Last Name*
Fourth Client Date of Birth*
Fourth Client Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
Fifth Client Name

First Name*

Middle Name

Last Name*
Fifth Client Date of Birth*
Fifth Client Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
Sixth Client Name

First Name*

Middle Name

Last Name*
Sixth Client Date of Birth*
Sixth Client Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
Seventh Client Name

First Name*

Middle Name

Last Name*
Seventh Client Date of Birth*
Seventh Client Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
Eighth Client Name

First Name*

Middle Name

Last Name*
Eighth Client Date of Birth*
Eighth Client Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
Ninth Client Name

First Name*

Middle Name

Last Name*
Ninth Client Date of Birth*
Ninth Client Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
Tenth Client Name

First Name*

Middle Name

Last Name*
Tenth Client Date of Birth*
Tenth Client Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
Client Address
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:
City:
State/Province:
Zip/Postal:
Parent or Guardian's Email Address

Email*

Confirm Email*
We send payment receipts by email to help minimize our footprint, save trees and stay green. By giving us your email address you are providing us with permission to contact you via email. We will never share your email address and you can breakup with us (or unsubscribe) at any time. We’ll only email you about specials, fun events, and the occasional super entertaining newsletter
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
If anything listed below applies to you, please consult your physician before using an infrared sauna.
ARE YOU TAKING PRESCRIPTION MEDICATIONS? Individuals who are using prescription drugs should seek the advice of their personal physician or a pharmacist for possible changes in the drugs effect when the body is exposed to infrared waves or elevated body temperatures. Some medications including diuretics, barbiturates, and beta-blockers and others may impair the body's natural heat loss mechanisms. Some over the counter drugs such as antihistamines may also cause the body to be more prone to heat stroke.*
No
Yes
DO YOU HAVE A CARDIOVASCULAR CONDITION? Individuals with cardiovascular conditions or problems (hypertension/hypo tension), congestive heart failure, impaired coronary circulation or those who are taking medications which might affect blood pressure should exercise extreme caution when exposed to prolonged heat. Heat stress increases cardiac output and blood flow in an effort to transfer internal body heat to the outside environment via the skin (perspiration) and respiratory systems. If using a pacemaker or defibrillator, please discuss risks involved with your physician.*
No
Yes
HAVE YOU CONSUMED ALCOHOL WITHIN THE LAST 12 HOURS? Contrary to popular belief, it is not advisable to attempt to "sweat out" a hangover. Alcohol intoxication decreases a person's judgment; therefore it might not be realized when the body has a negative reaction to high heat. Alcohol also increases the heart rate, which may be further increased by heat in the infrared sauna.*
No
Yes
DO YOU HAVE ANY CHRONIC CONDITIONS? Various chronic conditions including Parkinson's, Multiple Sclerosis, Central Nervous System Tumors, and Diabetes with Neuropathy are associated with impaired sweating. Please consult a physician before use if you have a chronic condition.*
No
Yes
DO YOU HAVE ANY JOINT INJURIES/ ENCLOSED INFECTIONS? If you have a recent joint injury, it should not be heated for the first 48 hours after injury or until the hot and swollen symptoms subside. If you have joints that are chronically hot and swollen, these joints may respond poorly to vigorous heating of any kind. Vigorous heating maybe contraindicated in cases of infections.*
No
Yes
DO YOU HAVE ANY IMPLANTS? Please consult your physician if you have metal pins, rods, artificial joints, silicone prostheses or any other surgical implants.*
No
Yes
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Have you ever had an Infrared Sauna session before?*
No
Yes
How did you hear about Salt Wellness Centre? *
Referral
Instagram
Facebook
Online Search/ Internet
Other Social Media
Walked By
Other
Why are you seeking Infrared Sauna Therapy? *
Detox
General Well being
Other
Pain relief
Relaxation
Weight Loss
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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