Infrared Sauna Consent Form

Infrared Sauna Consent Form

Liability Waiver and Professional Agreement At Northern Arizona Massage Therapy, we make all reasonable efforts to ensure a comfortable, clean and safe environment. To ensure you have a safe and comfortable experience, please answer the following questions and read the following guidelines then sign your name. This form is mandatory and required to be completed prior to any services being offered.
Basic Information
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Consent Form and Guidelines
PLEASE READ THE FOLLOWING INFORMATION AND ACKNOWLEDGE THAT YOU UNDERSTAND AND ACCEPT ALL PROVISIONS BY SIGNING BELOW.

It is our intention to keep you as well informed as possible. This means informing you how to operate the equipment. The proper procedure to follow will be clearly explained by a member of our staff. Please feel free to ask any questions.
PLEASE ANSWER THE FOLLOWING QUESTIONS
Have you ever used an infrared sauna before?*
Are you pregnant?*
Are you taking any medications?*
If YES, what medication(s)?
Diagnosed with any medical condition, such as Anhidrosis, that may limit or prevent your ability to sweat?*
Do you have unstable angina?*
Have you had a recent heart attack?*
Do you have severe arterial disease?*
Have you been diagnosed with any other medical condition? *
If YES, what medical condition(s)?
If you answered “yes” to any of the above questions; have you consulted with your medical provider about using an infrared sauna? *
I, the willing customer, UNDERSTAND and AGREE to:
- I will not be under the influence of alcohol or drugs before or during a session
- Clients using any medications must consult a physician or pharmacist prior to the use of the sauna.
- No one under the age of 18 is permitted in the far infrared sauna unless accompanied by a supervising adult.
- I will discontinue the use of the sauna if I feel light-headed, dizzy or heat exhausted.
- Sauna sessions should be limited to no more than 45 minutes and temperatures must stay below 150 degrees Fahrenheit.
- Plastic water bottles, cell phones, and other electronic devices are not permitted in the sauna. Wearing jewelry in the sauna is not advised.
- Pregnant women should consult their physician prior to the use of the sauna. Excessive body temperatures have apotential for causing fetal damage during the early days of pregnancy.
- Upon using this infrared sauna, I absolve NORTHERN ARIZONA MASSAGE THERAPY, LLC, employees and agents from any and all liability in connection with the use thereof whether such loss or damage is direct or indirect
- I am choosing to use the infrared sauna of my own free will and agree not to hold the facilities, operators or owners liable for any injury to self or for loss/damage of personal items
Infrared Sauna Contraindications
Medications: Individuals who are using prescriptions drugs should seek the advice of their physician or pharmacist for possible changes in the drugs effect when the body is exposed to infrared waves or elevated body temperature.

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.

The Elderly: The ability to maintain core body temperature decreases with age. This is primarily due to circulatory conditions and decreased sweat gland function. The body must be able to activate its natural cooling processes to maintain core body temperature. When using with the elderly, operate at a lower temperature and for no more than 15 minutes at a time.

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 thirty (30) beats per minute for each 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 reaction to 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: Multiple Sclerosis, Central Nervous System Tumors and Diabetes 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.

Insensitivity to Heat: An individual with insensitivity to heat should not use an infrared sauna.

Joint Injury: If you have a recent (acute) joint injury, it should not be heated for the first 48 hours after injury or until the swelling subsides. If you have a joint or joints that are chronically hot and swollen, these joints 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 are not heating by this system. Nevertheless, you should consult your physician prior to using an infrared sauna.

Pacemaker / Defibrillator: The magnets used to assemble this wooden sauna can interrupt the pacing and inhibit the output of pacemakers. Please discuss with your doctor the possible risks this may cause.
Proper Hydration
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 4 oz. of water prior to entering the sauna and a minimum of 8 oz. of water after sauna use.
By signing below, I have read and understand the above statements and agree to comply with the rules of this facility.*

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Date*

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Parent / Legal Guardian Permission for Minors
I ,First Name Last Name , HEREBY GIVE MY PERMISSION AS A PARENT/GUARDIAN of First Name Last Name who is years of age to utilize the infrared sauna at this facility.
I have read and fully understand this Client Release and Informed
Consent Form and hereby agree to accept all of the provisions.
Signature

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Date

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Should be Empty:

Infrared Sauna Consent Form

Basic Information

Consent Form and Guidelines

Infrared Sauna Contraindications

Proper Hydration

Parent / Legal Guardian Permission for Minors