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Cryo Fire Health Spa & Cryo Wellness Health Spa

 

 

 

 

 

I understand the services provided by Cryo Fire and Cryo Wellness Health Spas are drugless, non invasive approaches to address physical, mental and emotional aspects. They can be used as complementary treatments to prescribed medications or as sole treatments. When used as complementary treatments, they can increase the effectiveness of prescribed medications and decrease the amount prescribed.

I Agree

Although published studies do indicate that these services have health benefits as an addition to more traditional forms of medicine, Cryo Fire and Cryo Wellness Health Spas do not claim to be a replacement for medical treatment of any kind. 

I Agree

I confirm that no warranty or guarantee, or other assurance, has been made to me covering the results of any of these services, products or equipment offered for use by Cryo Fire and Cryo Wellness Health Spas.

I Agree

I hereby relieve them and hold them harmless from all liabilities for injury or damage that may occur to me. I fully understand the administration of the process, including possible adverse reactions, side effects, or other possible complications.

I Agree

These services should be avoided during the acute phase of any illness, including the following: infections accompanied by fever, acute active tuberculosis, cardiac insufficiency, COPD in third stage, bleeding, spitting of blood, contagious ailments, have use of an oxygen tank to aid breathing, alcohol or drug intoxication, unstable or uncontrolled hypertension, and acute stages of respiratory diseases.

I Agree

In the event of an emergency, I authorize Cryo Fire and Cryo Wellness Health Spas to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my immediate care and I agree that I will be responsible for payment of any and all medical services required.

I Agree

I declare that I am not under the influence of any substance, legal or otherwise, that would impair my judgment while using the services at Cryo Fire or Cryo Wellness Health Spas.

I Agree

I will abide by the 24 hour cancellation policy when rescheduling or canceling appointments. Otherwise, I understand that I will be charged the full session price, realizing that this appointment time was exclusively reserved for me.

I Agree

I, as a client, hereby release Cryo Fire and Cryo Wellness Health Spas, and its directors, officers, employees, agents and professional staff from all actions, causes of actions, suits, claims, liability, damages and demands of any kind, whether direct, indirect, special, exemplary or consequential, including interest therein of Cryo Fire and Cryo Wellness Health Spas which may occur as a result of any injury including death sustained by myself or others resulting from the receipt of services.

I Agree

I fully understand the above disclaimer and acknowledge that I am voluntarily participating in this service and use the provided services at my own risk. It is understood that this CONSENT is being given in advance of any administration of the process.

I Agree

Pregnant women should consult the physician prior to use of services.

I Agree

I understand that if I am experiencing seizures of have a history of seizures, I must have another trusted adult present during my sessions should I require immediate attention.

I Agree

Cryotherapy

During the session, you must ensure your head remains above the level of the gasiform air; while non-toxic, it is devoid of oxygen and may cause shortness of  breath, fainting, or other conditions.

I Agree

You must immediately notify the attendant and end the session if you at any time experience any physical or mental discomfort, problems, pain or anxiety.

I Agree

Abnormal skin sensitivity to cold may be caused by lotions, piercings, or medication, including but not limited to, tranquilizers and high blood pressure medication - do not use Cryotherapy if you have reason to believe you have come into contact with or ingested any such product.

I Agree

Do not use whole body cryotherapy if you have or may have any of the following conditions: Pregnancy, Stage 2 Hypertension (BP >160/100), acute or recent myocardial infarction, unstable angina pectoris, arrhythmia, symptomatic cardiovascular disease, cardiac pacemaker, peripheral arterial occlusive disease, venous thrombosis, acute or recent cerebrovascular accident, uncontrolled seizures, Raynaud's Syndrome, fever, tumor disease, symptomatic lung disorders, bleeding disorders, severe anemia, infection, claustrophobia, cold allergy, age less than 18 years (parental consent to session needed), acute kidney and urinary tract diseases. Consult physician regarding other injuries or illnesses prior to using cryotherapy.

I Agree

Risks of whole body cryotherapy include but are not limited to: fluctuations in blood pressure, allergic reaction, claustrophobia, anxiety, skin sensitivity or skin irritation.

I Agree

Spot Cryotherapy

Consult physician before using.

I Agree

Infrared Sauna

I agree to discontinue use if I feel dizzy or light-headed.

I Agree

I understand I need to stay hydrated to maintain proper hydration levels.

I Agree

I do not have a pacemaker and understand that serious repercussions can occur if a pacemaker comes into contact with infrared.

I Agree

Chiropractic Services

I understand that all chiropractic services, acupuncture, dry needling, adjustments, and other services offered, are available and performed on me with my full consent and understanding, and I release Cryo Fire and Cryo Wellness Health Spas, and Dr. Michael Alton from any claims, actions, causes of actions, suits, damages or demands of any kind which may occur as a result  of any injury including death sustained by myself or others resulting from the receipt of services.

I Agree

Hyperbaric Oxygen Chamber

The hyperbaric oxygen therapy has been reported to have beneficial effects for a wide range of conditions, without negative side effects. I understand, however, that there are risks. Ear discomfort can occur if you do not equalize your ears. Yawning, chewing, swallowing aid in this discomfort. If you are unable to equalize your ears, you must tell an attendant immediately.

Reschedule if you have a severe head cold.

I Agree

Pregnancy - Hyperbaric is not allowed during the first trimester. Consult your physician.

I Agree

Massage

I understand that massage therapy is provided for stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow. If I experience discomfort, I will immediately tell the massage therapist.  I will not hold my massage therapist responsible for any pain or discomfort I experience during or after the session.

I have notified my therapist about all of my medical conditions and injuries.

I understand that massage is entirely therapeutic.

I hereby waive and release my therapist from any and all liability, past, present, and future, relating to massage therapy and bodywork.

I Agree

Cupping

Cupping is an adaptation of an ancient technique that promotes health and healing by loosening soft tissue and connective tissue, scarring and adhesions moving stagnation and increasing lymphatic flow and circulation. This therapy utilizes silicone or plastic cups and a vacuum pistol to create suction on the body surface.

I understand I may have redness, tenderness, itching and discoloration after the service.

People on blood thinners should not use this service.

I Agree

 

Compression Therapy

I understand that I am using the compression therapy at my own risk and will not hold Cryo Fire or Cryo Wellness Health Spas responsible for any injury related to the use of the therapy.

I Agree

LED Therapy

I understand that there are benefits and risks to the use of LED therapy, and I agree not to hold Cryo Fire or Cryo Wellness Health Spas responsible for any injury related to the use of the therapy.

I Agree

 

 

 

 

 

First Clients Name

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First Clients Date of Birth*
First Clients Signature*
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Second Clients Date of Birth*
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Third Clients Date of Birth*
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Eighth Clients Name

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Ninth Clients Name

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Tenth Clients Name

First Name*

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Tenth Clients Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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 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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