Infrared Sauna Information Form

Please fill this form before your infrared sauna session.

First name*

Last name*

Birthday*

Month

Day

Year

Address*

Email*

Phone*

Emergency Contact Name & Phone*

Do you have any current illnesses or injuries?*

Yes

Are you Pregnant?*

Yes

Do you have high blood pressure or cardiac problems?*

Yes

*if you answered yes to any of these questions it is recommended you consult a physician before using Infrared Sauna Therapy.*

Check box

The use of any type of drug, medication, or alcohol prior to using Infrared Sauna Therapy may have adverse effects including, but not limited to dizziness, dehydration, or unconsciousness.

It is recommended you stay fully hydrated before, during, and after this treatment

Children under the age of 16 must be accompanied by a supervising/consenting adult.

Exit the sauna if you begin to feel light headed or dizzy.

I have received and understand all instructions regarding the safe use of the infrared sauna and agree to follow these instructions.

I understand that it is my responsibility to monitor my physical condition during the session.

I hereby release and hold harmless Whitening Bar, its owners, employees, and agents from any and all liability, claims, or causes of action arising out of or related to my use of the infrared sauna, including but not limited to personal injury, property damage, or loss.

By signing below, I confirm that I have read, understood, and agree to the terms and conditions of this consent waiver form.

Signature*

Signature field is empty.

Date*

Month

Day

Year

Parent/Guardian Signature If you are under age of 16 Parent consent is required.

Signature field is empty.

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Infrared Sauna Information Form

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