Salt Room Disclaimer / Release Form

Dolce Medical Spa, Organic Salon & Salt Room's Salt Therapy is 100% natural, safe and drug free, providing effective long-term relief. It can be used as a complimentary treatment to prescribe medications or as a sole treatment. When salt care is used as a complimentary treatment, it can increase the effectiveness of prescribed medications and decrease the amount subscribed. *

I have read and understand the above statement

Although published studies do indicate that Salt Therapy has health benefits as additions to more traditional forms of medicine, Dolce Medical Spa, Organic Salon & Salt Room does not claim to be a replacement for medication or any medical treatment of any kind. Only your personal physician or other health professional can best advise you on matters of your health. The research supporting the use of Salt Care was undertaken outside of the USA and hasn’t been filed with the FDA for approval. *

I have read and understand the above statement

Salt Therapy 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 have read and understand the above statement

I, as a client of Dolce Medical Spa, Organic Salon & Salt Room, hereby release it 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 which may occur as a result of any injury including death sustained by myself or others resulting from receipt of Salt Care. *

I have read and understand the above statement

Date of appointment *

Date

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Please enter a valid phone number.

Email *

example@example.com

By typing my name below, I fully understand the above disclaimer and use of the Salt Room at my own risk. *

How did you hear about us? *

Groupon Friend Driving by Internet search