Ellicottville Salt Cave Customer Intake form

Please carefully read the following information. A referral from your primary care provider may be required prior to service. If you answer yes to any of the following questions, please explain.
Have you ever experienced a Salt Cave before? If yes, how recently?
Where?
Please list any respiratory issues.
Asthma, TB, Cystic Fibrosis, Allergies, Sinusitis, etc
Are you pregnant? If yes, how many weeks?
Have you had a massage before?

Salt Cave Clients
Our cave is video monitored 24/7 for the purpose of securing the safety of all our guests during their visit. Please do not touch the walls, water features, or other items in the cave unless otherwise advised. Children must be supervised at all times while in the cave. They are not allowed near the water feature. They may not climb on the walls. Thank you for upholding our policy!

You may experience a dry throat and increased coughing after your first session. This is a natural part of the clearing process of the respiratory system. The pollution which has accumulated over time is being released by the salt and is then expelled from within the deepest regions of the lungs. I understand that salt therapy session should not be construed as a substitute for medical examination, diagnosis or treatment and that I should see a physician or other qualified medical specialist for any ailment of which I am aware. Salt therapy should not be performed under certain medical conditions.
We reserve the right to refuse or discontinue treatment according to medical conditions, noncompliance with ethical codes or sexual misconduct. I attest that all of the above is true and to the best of my knowledge. I affirm that I have stated all my known medical conditions and answered all questions honestly

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Massage Clients
I understand that massage is not a replacement for medical care and that no diagnosis will be made. We reserve the right to refuse or discontinue treatment according to medical conditions, noncompliance with ethical codes or sexual misconduct. I attest that all of the above is true and to the best of my knowledge. I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner’s part should I fail to do so.

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Sauna Clients
Please be cautious and open the door of the sauna to allow cool air to come in if you are too hot. We will set your first session at a lower temperature.
I, the undersigned, consent to the Infrared Sauna Treatment. I understand that these procedures are for the purpose of detoxification and are not intended to take place of medical care or medications. I clearly confirm that I do not have any contraindications to the Infrared Sauna Treatments. I understand that I can discontinue my treatments at anytime. I understand that I take full responsibility for my own health and well-being.I have read the above disclaimer (including cautions and contraindications for the use of the Infrared Sauna)

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Ellicottville Salt Cave