Halotherapy Intake + SOE Consent Form + Infrared Sauna Intake Logo
  • Intake Form: Halotherapy

    Intake Form: Halotherapy

  • Please fill out the form below:

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  • Halotherapy should not be undertaken if you are currently experiencing the following:

    • Active Tuberculosis
    • Fever
    • Acute Inflammatory Disease
    • Contagious Conditions
    • Severe/Unstable Heart Disorders
    • Stage 3+ COPD
    • Intoxication
    • Spitting Up Blood
    • Uncontrolled blood pressure
    • Severe Kidney Disease
    • Any Internal Disease In Acute Stage
    • Require Oxygen

     IF YOU HAVE ANY QUESTIONS. DO NOT HESITATE TO ASK!

    Please Note: This is a fragrance free establishment. Any perfumes, smoke, or scents may cause a severe reaction in others. Salt of the Earth reserves the right to refuse service for any reason. 

    Please, be sure to drink plenty of water after each visit! Water will be provided!

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  • Consent Form

    Consent Form

  • Halotherapy is a 100% natural and drug-free treatment. It can be used as a complementary treatment to prescribed medications or as a stand-alone therapy. When used as a complementary therapy. it may increase the effectiveness of prescribed medications and decrease the amount needed.

    Although studies conducted outside of the USA do indicate that Halotherapy appears to have health benefits as an addition to more traditional forms of medicine, Salt of the Earth does not claim to be a replacement for medication or any medical treatment of any kind. Only your physician can best advise you on matters of your health. Research supporting the use of Halotherapy has not been evaluated by the FDA.

    As a client of Salt of the Earth Halotherapy, LLC, I have requested Halotherapy. I understand the nature of Halotherapy, the potential benefits, risks, and consequences have been explained to me and all of my questions have been answered to my satisfaction.

    I hereby acknowledge the unproven and unconventional nature of Halotherapy and have requested the therapy notwithstanding.

    I am satisfied and understand the information provided as I acknowledge that Salt of the Earth Halotherapy, LLC takes no responsibility for clients choosing to treat themselves by means of Halotherapy, which has not been evaluated by the FDA, and is not intended to diagnose, treat, cure or prevent any disease.

    I understand that for all my concerns, it is my responsibility to consult an appropriate licensed healthcare practitioner. I further release Salt of the Earth Halotherapy, LLC from any legal ramifications should injury, death, or illness occur as a result of Halotherapy.

    Cubbies have been provided for your convenience; SOTEH is not responsible for personal items.

    I have read Salt of the Earth, Halotherapy's Etiquette information and agree to adhere to these policies.

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  • Disclaimer

    Disclaimer

  • Salt Therapy Association Providing the healthy benefits of Salt Therapy
  • The information contained both herein and on our website is designed to disseminate general information. It is not intended to give medical or pharmacological advice, and as such, should not be relied upon as a substitute for professional medical advice.

    I understand and acknowledge that by entering the premises and employing any of the services offered by Salt of the Earth Hatotherapy, LLC (referred to as SOTEH).

    1. I assume all known, latent or anticipated risks;

    2. My participation at SOTEH is purely voluntarily and no warranties or representations were made to me by its management to induce me to participate;

    3.1 shall assume full responsibility for myself and any of my guests and/or invitees;

    4.I understand that SOTEH does not evaluate or diagnose my health and I have received medical clearance prior to engaging in SOTEH activities;

    5.I have been advised of the following possible side effects: Dry or itchy throat, nasal drip, and increased coughing at the beginning. This is a natural part of the cleaning process of the respiratory system, during which the potlution, accumulated over time, and now loosened up by the salt, is expelled from even the deepest regions of the lungs. Such side effects should cease with the removal of pollution and pathogens. Skin irritation and dermal sensitivity may occur. In such cases, decrease the frequency of sessions.

    6.SOTEH has neither applied for or received approval by the Food and Drug Administration or any other consumer protection group.

    7. The use of the rooms at SOTEH has not been evaluated by the Food and Drug Administration or any other agency.

    8. The use of SOTEH is not intended to treat, cure or prevent any illness or condition. All medical conditions should be treated by a physician competent in treating that particular condition. SOTEH assumes no responsibility for customers choosing to treat themselves.

    9. All products and services provided by SOTEH, including written information, labels, brochures and flyers, as well as information provided orally or in any other medium of communication, have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure or prevent any disease. For all your health concerns, please consult an appropriately licensed healthcare practitioner.

    The use of halotherapy is not intended to substitute for medical care or treatment. Do not stop your medication without first consulting with your doctor or medical professional Halotherapy is NOT a substitute for any conventional medication. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have any questions about Halotherapy or possible contraindications, please consult with your physician or health professional.

    LIMITATION OF LIABILITY. YOU AGREE THAT NEITHER SOTEH, NOR ANY PERSON ASSOCIATED WITH SOTEH, SHALL BE LIABLE FOR ANY DAMAGE RESULTING FROM YOUR USE OF SOTEH AND ITS FACILITIES. THIS LIMITATION OF LIABILITY COVERS CLAIMS BASED ON WARRANTY, CONTRACT, TORT, STRICT LIABILITY, AND ANY OTHER LEGAL THEORY. THIS PROTECTION COVERS SOTEH, ITS MEMBERS, EMPLOYEES, AGENTS, VOLUNTEERS, AND SUPPLIERS. THIS PROTECTION COVERS ALL LOSSES INCLUDING, WITHOUT LIMITATION, DIRECT OR INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY, AND PUNITIVE DAMAGES, PERSONAL INJURY/WRONGFUL DEATH, LOST PROFITS, OR DAMAGES RESULTING FROM USE OF SOTEH AND ITS FACILITIES.

    I agree to comply with all SOTEH policies and rules, including but not limited to all SOTEH policies, guidelines, signage, and instructions. Because the SOTEH is open for use by other individuals, I recognize that I am at higher risk of contracting COVID-19. With full awareness and appreciation of the risks involved, I. for myself and on behalf of my family. spouse, estate, heirs, executors, administrators, assigns, and personal representatives, hereby forever release, waive, discharge, and covenant not to sue SOTEH, its board members, officers, agents, servants, independent contractors, affiliates, employees, successors, volunteers, and assigns (collectively the "Released Parties") from any and all liability, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, or injury, including death, that may be sustained by me related to COVID-19 whether caused by the negligence of the Released Parties, any third-party using SOTEH, or otherwise, while participating in any activity while in, on, or around SOTEH and/or while using any SOTEH facilities, tools, equipment or materials.

    SOTEH reserves the right to alter or modify the above terms and conditions from time to time. Your acknowledgment above constitutes your agreement to any and all terms changed, modified or altered. It is in your best interest to view our website periodically for the latest terms and conditions.

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  • Intake Form: Infrared Sauna

    Intake Form: Infrared Sauna

  • It is always important to maintain proper hydration levels during infrared therapy. Dehydration will actually increase carbohydrate utilization and cause less fat to be burned for energy. We highly recommend drinking a minimum of 8 oz. of water prior to entering the sauna and a minimum of 8 oz. of water after sauna use.

    Infrared Sauna Agreement/Acknowledgement

    1. The use of drugs, medication or alcohol prior to or during the sauna session may lead to dizziness or unconsciousness.

    2. Please consult your physician if you are in doubt to use the infrared for health reasons.

    3. No one under the age of 18 is permitted in the far infrared sauna unless accompanied by a supervising adult.

    4.Discontinue the use of the sauna if you feel light-headed or heat exhausted.

    5. Sauna sessions should be limited to no more than 45 minutes and temperatures must stay below 150 degrees Fahrenheit.

    6. Water bottles are not permitted in the sauna.

    7. Clients using and medications should consult their physician or pharmacist prior to the use of the sauna.

    8. Pregnant women should consult their physician prior to the use of the sauna. Excessive body temperatures have a potential for causing fetal damage during the early days of pregnancy.

    Contradictions

    • Medications: Individuals who are using prescription drugs should seek the advice of their physician and/or pharmacist for possible changes in the drugs effect when the body is exposed to infrared waves or elevated body temperatures. 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 cause the body to be more prone to heat stroke.
    • Children and the Elderly: infrared saunas are safer for children and elderly individuals as they are effective at lower temperatures. However, the core body temperature of children rises much faster than adults and the ability to maintain core body temperatures decreases with age. Children under 6 should not use the sauna. Children and elderly individuals should not use for more than 15 minutes.
    • 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 thirty (30) beats per minute foreach degree increase in core body temperature.
    • Alcohol/Alcohol Abuse: Contrary to popular belief, it is not advisable to attempt to "sweat out" a hangover. Alcohol intoxication decreases a person's judgment; therefore, he/she may not realize when the body has a negative reactionto high heat. Alcohol also increases the heart rate, which may be further increased by heat stress.
    • Chronic Conditions/Diseases associated with a reduced ability to sweat or perspire: Multiple Sclerosis, Central Nervous System tumors and Diabetics with neuropathy are conditions that are associated with impaired sweating.
    • Hemophiliacs/Individuals prone to bleeding: The use of infrared saunas should be avoided by anyone who is predisposed to bleeding.
    • Fever: An individual who has a fever should not use an infrared sauna until the fever subsides.
    • Insensitivity to heat: An individual with insensitivity to heat should not use an infrared sauna.
    • Pregnancy: Pregnant women should consult a physician before using an infrared sauna.
    • Menstruation: Heating of the low back area of women during the menstrual period may temporarily increase their flow.
    • Joint Injury: If you have a recent injury, it should not be heated for the first 48 hours after an injury or until the swollen symptoms subside. If you have a joint or joints that are chronically hot and swollen, these joints may respond poorly to vigorously heating of any kind.
    • Implants: Metal pins, rods, artificial joints or any surgical implants generally reflect infrared waves and thus are not heated by this system. Nevertheless, you should consult your physician prior to using an infrared sauna.
    • Pacemaker/Defibrillator: The magnets used to assemble our saunas can interrupt the pacing and inhibit the output of pacemakers. Please discuss with your doctor the possible risks this may cause.

    I acknowledge and accept the risks inherent in the use of the sauna. I voluntarily assume the risk of injury, accident, or death which may arise from the use of the sauna. I and my heirs, executors, representatives, or assigns hereby release all claims or liabilities for personal injury or property damages of any kind sustained while on the premises, during the use of the sauna, and from any advice provided by an employee, independent contractor, volunteer, or any representative.

    I further understand the Salt of the Earth Halotherapy, LLC is NOT a medical doctor and is NOT attempting to portray or conduct the activities of a medical doctor, and I release the facility and manufacturer from any adverse effects I may incur by the use of the sauna. I have carefully read the above safety instructions for using a Sunlighten sauna. I fully understand them and fully agree to comply with the instructions. This agreement is in effect for all sauna sessions and will not expire unless requested in writing by either party. My signature acknowledges that I have read and agree to receive the sauna session or series of sessions and will adhere to all of the aforementioned statements that I have initialed.

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  • FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINOR (UNDER AGE 18 AT TIME OF REGISTRATION): This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release provided above of all the Releases and for myself, my heirs, assigns, and next of kin, release and agree to indemnify and hold harmless the Releases from any and all liability incidents to my minor child's involvement or participation in these services as provided above, to the fullest extent permitted by law.

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