INFRARED SAUNA CONSENT AND RELEASE FORM

Name: ________________________________________________________

Address: ______________________________________________________

DOB: ___________________ Phone/Cell Phone: ____________________

Email: ________________________________________________________

Emergency Contact: _____________________________________________

Physician: _____________________________________________________

Have you ever used an Infrared Sauna before? ☐Yes ☐No

Please, list any allergies you may have:

____________________________________________________________________________

Please list any medications you are currently taking:

____________________________________________________________________________

Is there anything else we should know?

____________________________________________________________________________

* If you answered YES to any of the above questions it is not recommended that you use the infrared sauna at this time. You need to get a consent form from your physician in order to proceed with infrared sauna therapy.

BEFORE YOUR SESSION:

• Drink plenty of water before and during your session. After the session drink water with electrolytes.

• It is helpful to have food/snack 1–2 hours before your session. You can even bring an apple or banana for after

the session.

• If you experience pain and/or discomfort, immediately discontinue and exit the sauna.

• If you are on any medications, consult with your doctor before using the infrared sauna.

• Do not use drugs, tobacco, or alcohol prior to or after the sauna session.

• No one under the age of 18 is permitted in the far infrared sauna unless accompanied with a guardian.

• Exit the sauna if you feel light-headed, dizzy, heat exhausted, or unwell.

Are you pregnant? ☐Yes ☐No

Do you currently have a fever, infection or injury? ☐Yes ☐NoHave you recently had high blood pressure, a heart attack or other cardiovascular problem? ☐Yes ☐No

Do you have a history of dizziness, fainting spells, heat sensitivity, narcolepsy or seizures? ☐Yes ☐No

Do you have a heart pacemaker or any other battery operated or electrical implant? ☐Yes ☐No

www.arawiseman.com 416.867.8155

DISCLAIMER / WAIVER

I consent to Far Infrared Sauna Treatment. I acknowledge and accept the risks inherent in the use of the Far infrared Sauna. I voluntarily assume the risk of injury, accident or death, which may arise from the use of the Far infrared Sauna.

I and any of my heirs, executors, representatives or assigns hereby release Ara Wiseman Nutrition & Healing from all claims or liabilities for personal injury while on her premises. I understand that these procedures are for the purpose of detoxification and are not intended to take place of medical care or medications. I confirm that I do not have any of the above contraindications to the Infrared Sauna treatments.

I have read the above disclaimer (including cautions and contraindications for the use of Far Infrared Sauna and I agree that I am not currently suffering with any of the above mentioned contraindications).

I fully understand that Ara Wiseman Nutrition & Healing are not medical doctors and I am not here for medical diagnostic or treatment procedures.

It is my responsibility and decision to do Far Infrared Sauna Therapy Sessions. It is also my responsibility to consult with my physician.

I have carefully read this agreement and understand it to be a full and final release of all costs, claims, causes of action and damages of any kind arising from or in connection with Far Infrared Sauna Therapy.

I certify that everything on this form is true and correct to the best of my knowledge.

Client Signature______________________________________ Date _______________________

www.arawiseman.com 416.867.8155