CONSENT AND AGREEMENT TO TREATMENT
By signing this client agreement, I consent and agree to:
ACKNOWLEDGMENT OF RISKS
I, the undersigned, understand and acknowledge that cryotherapy treatments involve exposure to extremely cold temperatures for a short period and that certain risks may be associated with this procedure. These risks include, but are not limited to:
- Skin irritation, discoloration, or frostbite if safety protocols are not followed.
- Temporary side effects such as cold sensitivity, tingling, or redness.
- Possible adverse reactions related to individual health conditions.
I confirm that I have been informed about the procedure, its benefits, and risks, and I voluntarily elect to proceed at my own risk.
1. Receiving cryotherapy treatments at Cryotherapy Restore and Rejuvenate LLC using equipment including the Antarctica WBC Electric cryotherapy chamber and Iceberg Electric Cryo system.
2. Following all instructions provided by the staff to ensure my safety throughout the treatment, including wearing protective gear during sessions.
3. Asking questions or requesting further clarification before proceeding if I feel uncertain about any aspect of the treatment.
MEDICAL HISTORY DISCLOSURE
To the best of my knowledge and ability, I affirm that:
- I have disclosed to the staff all relevant medical conditions, medications, and personal health information that may impact the safety of my treatment.
- I am not currently pregnant, and I do not have any of the following contraindications that would make me ineligible for cryotherapy, such as:
- Severe hypertension.
- Raynaud’s disease.
- Unmanaged heart problems.
- Nerve damage, cold allergies, or conditions aggravated by extreme cold.
I understand that it is my responsibility to consult with my healthcare provider prior to participating in cryotherapy and to notify the staff of any changes to my health or medical status before future sessions.
LIMITATION OF LIABILITY
I voluntarily release Cryotherapy Restore and Rejuvenate LLC, including its staff, representatives, and affiliates, from any liability for injury, illness, adverse reactions, or damages resulting from or related to my participation in cryotherapy treatments. By signing below, I acknowledge and agree that:
- I assume full responsibility for risks associated with these treatments, including unforeseen complications or reactions.
- I will not hold Cryotherapy Restore and Rejuvenate liable for: i) injuries or outcomes resulting from failure to provide accurate medical information, ii) failure to adhere to provided instructions and safety protocols during treatments, and iii) adverse reactions resulting from pre-existing conditions or circumstances beyond the staff’s control.
PHOTO CONSENT (Optional)
I hereby give permission for Cryotherapy Restore and Rejuvenate to take and use photographs or videos of my session(s) for promotional purposes, including social media, marketing materials, and website content.
- I consent.
- I do not consent.
FINAL AGREEMENT
By signing below, I confirm that:
- I have read, understood, and voluntarily agree to all terms set forth above in this client agreement.
- All the information provided by me is accurate and complete to the best of my knowledge.
- I will abide by the guidance and protocols provided by Cryotherapy Restore and Rejuvenate LLC to ensure a safe experience.
- I voluntarily assume all risks related to my cryotherapy treatment and release Cryotherapy Restore and Rejuvenate LLC from any and all liability related to potential injuries, adverse reactions or outcomes related to my use of these services.
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Thank you for trusting Cryotherapy Restore and Rejuvenate LLC. Your wellness and safety are our top priorities!