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FLOATATION AND INFRARED SAUNA FORM



By signing this waiver, you agree to the following regarding our various services and cancellation policy:

I have completed this form to the best of my ability and knowledge and agree to inform the spa of any changes in the above information. I have been informed of and understand the contraindications to the requested services and agree that I do not have any condition(s) that would make the requested service unsuitable. I agree to waive all liabilities toward the business for any injury or damages incurred due to the misrepresentation of my health history.


INFRARED SAUNA

 

I understand that the sauna can reach 130 degrees Fahrenheit that any of the below contraindications will require me to use discretion for my own wellbeing. I acknowledge that severe medical conditions or pregnancy will require a note of authorization from my doctor prior to the use of the infrared sauna:

 

Medications: Diuretics, barbiturates, and beta-blockers may Impair the body's natural heat loss mechanisms. Anticholinergics such as amitriptyline may Inhibit sweating and can predispose Individuals to

heat rash or, to a lesser extent, heat stroke. Some over the counter drugs, such as antihistamines, may also cause the body to be more prone to heat stroke.

 

Pregnancy/breast feeding: Pregnant women should consult a physician and get written consent before using the Infrared sauna. If breastfeeding, do not use the sauna. The detoxification process can expel

toxins into your breast milk.

 

Menstruation: Heating of the low back area during your menstrual period may temporarily Increase menstrual flow.

 

Elderly: The body must be able to activate Its natural cooling processes in order to maintain a core body temperature. As we mature, our bodles naturally lose this capability. Guests over the age of 70 will

be permitted for Infrared sauna use, but at a lower temperature

 

Cardiovascular conditions: Individuals with cardiovascular conditions or problems (hypertension/hypotension), congestive heart failure, Impaired coronary circulation, or those who are taking medications

which might affect blood pressure should exercise 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 system. This takes place primarily due to major changes in the heart rate, which has the potential to increase by 30 beats per minute for each

degree increase in core body temperature.

 

Alcohol/Alcohol abuse: It is not advisable to "sweat out" a hangover. Alcohol Intoxication decreases a person's judgement, and they may not recognize a negative reaction to high heat. Alcohol also

Increases the heart rate, which may be further Increased by neat stress, Guests who appear intoxicated or inform us or alcohol consumption prior to use or the sauna will forfeit their scheduled appointment and no refund or credit will be Issued.

 

Chronic conditions/diseases associated with reduced ability to perspire: Multiple sclerosis, central nervous system tumors, and diabetes with neuropathy are conditions that are associated with Impaired sweating, and we recommend speaking with a doctor before using the sauna.

 

Hemophiliacs/Individuals prone to bleeding: Do not use the sauna

 

Fever: We recommend avoiding the use of a sauna until your fever subsides.

 

Joint Injury: If you have a recent (acute) joint Injury, it should not be heated for the first 48 hours of Injuring or until swollen symptoms subside. If you have joints that are chronically hot and swollen, they

may respond poorly to vigorous heating of any kind.

 

Implants: metal pins, rods, artificial joints, or any other surgical Implants generally reflect infrared waves and thus will not be heated by this sauna system. Nevertheless, you should consult your physician

prior to using an Infrared sauna.

 

Pacemakers/defibrillators: the magnets used to assemble Infrared saunas can Interrupt the pacing and inhibit the output of pacemakers. Please discuss with your doctor the possible risks this may cause.

 

>> I have read and understand the above contraindications. I understand that if I use the sauna and experience any pain or discomfort, that I will Immediately discontinue sauna use and exit the sauna.

 

 

FLOATATION THERAPY SESSIONS

 

I agree to NOT use the float pod under any of the following circumstances:

 

- If I have not showered thoroughly with the provided "pre-float" body wash provided by our spa to remove any creams, oils, or makeup

- If I have had any type of hair color/treatment within the past two weeks or have any hair color that would bleed into the water or onto a white towel

- If I am under the Influence of drugs or alcohol

- If I have a communicable or Infectious skin condition, disorder, or disease

- If I have open sores

- If I am diabetic, unless my diabetes Is under medical control

- If I have a history of heart trouble, epilepsy, seizures, or blackouts, and have not received my doctors (written) permission to use the float pod

- If I am menstruating or experiencing some other sort of external vaginal Issues

- If I have a condition which may be adversely affected by cutaneous absorption of magnesium

- If I have kidney disease and have not received my doctor's (written) permission to use the float pod

- If I may release bodily fluids, voluntarily or involuntarily, Into the float pod

Please note: Our staff Is not trained in assisted transfers. If you need assistance getting In or out of the float pod, it is best for you to bring your own helper.

 

>> I have read and understand all the terms listed above. I understand that violation of any of these rules that result in contamination of the float pod water may result in a

cleaning and salt replacement fee of up to $1000

 

CANCELLATION POLICY

 

 I agree to the 24 hour cancellation policy. If I am a No-Show or last minute cancellation, I agree to pay for my service in full. If a gift certificate was used to reserve my spot, the voucher will be voided. Cancellation must be by phone or email at least 24 hours before my service. I understand my service starts at the designated appointment time and if I am late, my service will be shortened to not affect the next person after me.



First Client Name

First Name*

Last Name*

Phone*
First Client Date of Birth*
First Client Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
First Client Signature*
Second Client Name

First Name*

Last Name*
Second Client Date of Birth*
Second Client Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Third Client Name

First Name*

Last Name*
Third Client Date of Birth*
Third Client Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Fourth Client Name

First Name*

Last Name*
Fourth Client Date of Birth*
Fourth Client Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Fifth Client Name

First Name*

Last Name*
Fifth Client Date of Birth*
Fifth Client Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Sixth Client Name

First Name*

Last Name*
Sixth Client Date of Birth*
Sixth Client Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Seventh Client Name

First Name*

Last Name*
Seventh Client Date of Birth*
Seventh Client Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Eighth Client Name

First Name*

Last Name*
Eighth Client Date of Birth*
Eighth Client Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Ninth Client Name

First Name*

Last Name*
Ninth Client Date of Birth*
Ninth Client Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Tenth Client Name

First Name*

Last Name*
Tenth Client Date of Birth*
Tenth Client Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
Parent or Guardian's Email Address

Email*

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

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.

By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Do you have a Gift card or Gift certificate?*
No
Yes

If yes, how much is the gift amount?
Are you currently pregnant?*
No
Yes

If yes, how far along?

Any high risk factors?
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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