Infrared Sauna Consent Form

Sauna use is by appointment only Please call 808-378-2400, visit www.blessedhandsiv.com or stop by the front desk to schedule an appointment. Consent to use the infrared sauna is conditional upon provision of accurate answers to the following questions and signing this agreement.

Full Name

Date of Birth

Address
City State Zip code
Phone#

Email

Reason for visit

How did you hear about us? If referred, by whom? (optional)

PLEASE ANSWER THE FOLLOWING QUESTIONS:
1. Are you pregnant? YESNO
2. Are you taking any medications? YESNO
3. Have you been diagnosed with any medical condition, such as anhidrosis, that may limit or prevent your ability to sweat? YESNO
4. Do you have unstable angina? YESNO
5. Have you had a recent heart attack? YESNO
6. Do you have a pacemaker or defibrillator? YESNO
7. Do you have any other surgical implants? (metal pin rod, artificial joint) YESNO
8. Do you have severe arterial disease? YESNO
9. Are you currently taking any diuretics, barbiturates, beta-blockers or antihistamines? YESNO
10. Have you been diagnosed with any other medical condition? YESNO
If “yes”, which condition?
If you answered “YES” to any of the above questions, have you consulted your medical provider and received authorization to use an infrared sauna?

It is always important to maintain proper hydration levels during far 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.

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 regarding your ability to use the far infrared sauna for health reasons.
3. No one under the age of 18 is permitted in the far infrared sauna unless accompanied by a parent/guardian.(Signature required below)
4. Discontinue the use of the sauna if you feel light-headed, dizzy or heat exhausted.
5. Sauna sessions are limited to one visit/day.
6. Hemophiliacs and persons that are inclined to hemorrhage should avoid infrared sauna usage or any type of heating that would generate vasodilation.
7. Clients using any medications must consult a physician or pharmacist prior to use of the sauna.
8. Pregnant women should consult their physician prior to use of the sauna. Excessive body temperatures have a potential for causing fetal damage during the early stages of pregnancy.
9. If you have suffered a recent joint injury that is considered acute, it should not be heated for at least 48 hours or until swelling diminishes
10. It is advised not to have a full stomach to avoid any ill feelings. A good rule of thumb is to not eat for about an hour prior to your sauna session.
11. Detoxification can be sudden for some people. These effects may include dizziness, nausea and fatigue. Most people do not experience these symptoms.

BEFORE YOUR APPOINTMENT
• Towels are provided for your comfort and sanitation. Use at least 2-3 towels. Sit on one towel folded over several times for added cushioning. Put another towel on the floor to absorb extra sweat. A third towel draped over the knees may aid you in comfort and is useful to towel off sweat.
• Be sure to towel off excess sweat during your session to help the body perspire more freely.
• To help relieve sore and tense muscles, massage the affected areas while in sauna to help heal faster.
• To regulate the temperature inside the sauna during your session, open the roof vent.
• If you feel the need for more cooling, simply leave the door open until the air around you feels comfortable enough. This experience should be calming, rejuvenating and wonderful!
• Drink plenty of fluids prior to, during, and after your session.
• Place towels in the laundry bins as you exit your suite.
• Remove all footwear prior to entering the sauna.
• Do not pour water on the heaters. Infrared saunas are intended to provide dry heat therapy.
• We highly recommend showering soon after your sauna session, as you should remove the toxins from the surface of your skin. However, you will continue to sweat for about an hour if you choose to wait.
• In an effort to maintain a peaceful, pleasant, and healthy environment for all our guests we respectfully request that all cell phones be turned on silent and conversations quieted before entering the suites.
• If you choose to sauna with a friend or loved one, please keep conversations and/or music to a considerate volume.
• Refrain from spraying any perfume while in your suite.
• Do not apply any oils on your body while sweating in the sauna
• Please take all personal belongings with you. Serenity Health & Wellness is not responsible for lost or stolen items.
• If you have any challenges keeping your scheduled appointment time, be sure to give us at least 24 hour notice. Appointments changed or cancelled within 24 hours of the scheduled time are charged in full.
• Relax, breathe deep, and enjoy the radiant warmth of your infrared experience!

I acknowledge and voluntarily assume the risk of injury, accident or death which may arise from the use of a far infrared sauna. I and any of 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 far infrared sauna and from any advice provided by an employee, independent contractor or any representative. I agree that this Application and Waiver is in effect for all far infrared sauna sessions and will not expire unless specifically requested by either party.

I further understand that the employees and practitioners at Blessed Hands IV Hydration & Wellness are not medical doctors and are not attempting to portray or conduct the activities of a medical doctor.

I have carefully read the above safety instructions for using the infrared sauna. I fully understand them and fully agree to comply with instructions. I agree that this Application and Waiver is in effect for all far infrared sauna sessions and will not expire unless specifically requested by either party.

I will consult with the staff of Blessed Hands IV Hydration & Wellness if I have further questions.