Cryo Waiver

YOUR INFORMATION:

ASSUMPTION OF RISK, WAIVER, AND RELEASE

By engaging Smiths Station Pharmacy and Cryo Wellness Spa (for the purposes hereof referred to together herein as the "Company") to provide cryotherapy(TruCryo/Kassen Pro), Radio Frequency,Cavi-Lipo,Laser Lipo, Vaccum Therapy (RejuvaFresh) Red Light/ infrared sauna (LZR Ultrabrite/Photons), PEMF (MagnaWave), Normatec /Rapid Reboot Compression equipment (Normatec Pulse 2.0), and related services ("Services") and using the Company's equipment and facilities in relation thereto, I hereby acknowledge on behalf of myself, my heirs, personal representatives and/or assigns, that there are certain inherent risks and dangers associated with receiving Services and my use of the Company's equipment and facilities. At all times, I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions given to me by staff. If in the subjective opinion of the Company's staff, I would be at physical risk in receiving Services, I understand and agree that I may be denied access to Services until I furnish the Company with an opinion letter from my medical doctor, at my sole cost and expense, specifically addressing the Company's concerns and stating that the Company's concerns are unfounded. 

I hereby (1) agree to assume full responsibility for any and all injuries or damage which are sustained or aggravated by me in relation to my receiving of the Services, (2) release, indemnify, and hold harmless the Company, its direct and indirect parent, subsidiary affiliate entities, and each of their respective officers, directors, members, employees, representatives and agents, and each of their respective successors and assigns and all others, from any and all responsibility, claims, actions, suits, procedures, costs, expenses, damages, and liabilities to the fullest extent allowed by law arising out of or in any way related to the Services, and (3) represent that: (a) I have no medical or physical condition that would prevent me from receiving the Services, (b) I do not have a physical or mental condition that would put me in any physical or medical danger, (c) I have not been instructed by a physician to not receive Services, (d) no warranty or guarantee, or other assurance, has been made to me covering the results of the Services, (e) knowing the risks involved I nevertheless chose to voluntarily request the Services. Notwithstanding the foregoing (and by way of illustration only and not limitation) if any of the following apply to me or if I'm unsure for any reason, I hereby acknowledge the Company's recommendation that I consult a medical physician before receiving Services.

Massage Therapy clients must sign a separate massage therapy waiver 

**If you have a Pace Maker or other electronic implanted device, please let us know immediately!

TruCryo/Kaasen Pro wellness treatments (pain/skin/overall wellbeing treatments)

• Severe Raynaud's 
• Severe Allergy to Cold 
• Progressive Diseases (MS, ALS, Parkinson's, Neuropathy) 
• Pregnancy/Breastfeeding 
• Bacterial and viral infections of the skin 
• Wound healing disorders 
• Circulatory disorders 
• Surgery in the past 6 months 
• Pacemaker/metal implants 
• Active/Severe Eczema, rashes, or dermatitis 
• Silicone/other implants in desired treatment area 
• Use of topical antibiotics in desired treatment area 
• Mesh inserts in the desired treatment area 
• Irremovable body piercings in the desired treatment area

TruCryo/Kaasen Facial:

• Severe Raynaud's 
• Severe Allergy to Cold 
• Progressive Diseases (MS, ALS, Parkinson's, Neuropathy) Botox in the past 30 days 
• Fillers in the past 90 days 
• Bacterial and viral infections of the skin 
• Wound healing disorders 
• Circulatory disorders 
• Metal implants 
• Surgery in the past 6 months 
• Active/Severe Eczema, rashes, or dermatitis 
• Silicone/other implants in desired treatment area 
• Use of topical antibiotics in desired treatment area 
• Irremovable body piercings in the desired treatment area 

Magna Wave PEMF/LZR Ultrabrite/Photons LED 

• Pregnancy - There has been little research on pulsed electromagnetic field therapy contraindications in this area. 
• Light sensitivity (LZR/LED Only) 
• Implanted Devices - PEMF exposure directly over devices could cause them to shut off. 
• Myasthenia gravis - Patients have reported improvement in muscle strength using pulsed electromagnetic field therapy. There is a chance that muscle weakness could be aggravated, causing autoimmune system to temporarily 
• worsen. 
• Active Bleeding (especially into the gut) -A pulsed electromagnetic field therapy contraindication could be increased bleeding. PEMF reduces platelet aggregation, and bleeding may not clot readily. Bleeding should be controlled before using PEMF. 
• Hyperthyroidism (and other glands) - A pulsed electromagnetic field therapy contraindication could be an over- stimulation of glands if used excessively at high intensities. This could aggravate glandular function. 
• Acute Viral Disease (active Tuberculosis) - PEMF should not be the primary treatment as white blood count responses may be temporarily dampened, resulting in brief flares. 
• PEMF is used only as a therapeutic therapy, not the major source of treatment. 
• Malignancies - Current evidence suggest no probable relationship to health problems with therapeutic low- frequency pulsed electromagnetic field therapy, there has not been much research in this area and caution should be exercised. PEMF should only be used as a complimentary therapy. 
• Psychoses - In combination with medicines, a pulsed electromagnetic field therapy contraindication could be a production of unpredictable results that could cause significant reductions in blood pressure. 
• hypotension/Hypertension - a pulsed electromagnetic field therapy contraindication of sudden significant blood pressure decrease may occur causing vertigo, fainting, etc. 
• Always talk to your doctor before starting any alternative treatment. Pulsed electromagnetic field therapy is often used alongside other modalities. PEMF is not thought to have negative side effects or complications when it is combined with conventional medical treatment.

Please also agree to remove all electronic devices from my person before utilizing Magna Wave PEMF as exposure could cause them to severely malfunction. This Includes but is not limited to; Vehicle keys, 

Hearing aids, cell phones, tablets, smart watches, wallets (credit cards), etc..

Normatec Pulse 2.0 compression or Rapid Reboot Compression 

• Acute pulmonary edema 
• Acute thrombophlebitis 
• Acute congestive cardiac failure 
• Acute infections 
• Deep vein thrombosis (DVT) 
• Episodes of pulmonary embolism 
• Wounds, lesions, infection, or tumors at or near the site of application Where increased venous and lymphatic return is undesirable 
• Bone fractures or dislocations at or near the site of application

RF/Cavi-Lipo/Laser Lipo/ Vacuum Therapy(s) 

Body sculpting treatments are not recommended if you are pregnant, breast feeding, have a lymphatic disorder, acute illness, metal implants, pacemakers, or are currently being treated for active cancer. 

The purpose of this waiver is to provide written information regarding the risks, benefits, and alternatives of the treatment this consent is written. It is important that the patient should fully understand the treatment priorly. Before signing the consent, the patient should ask any of the questions regarding the treatment.

In participating in the Services, you may be photographed, videoed or otherwise recorded by the Company for safety, monitoring and training purposes. You hereby consent to such usage of your imagery for all and any such purpose by the Company and hereby agree that the Company without any payment to you shall in all cases be the sole owner of all intellectual and other proprietary rights therein without any restriction whatsoever. 

Your participation in the Services will expose you to extremely cold temperatures. I have read this Assumption of Risk, Waiver, and Release, fully understand its terms, and understand that I am giving up substantial rights including my right to sue the Company under certain circumstances. I acknowledge that I am signing this waiver freely and voluntarily. The term of this waiver is indefinite. I acknowledge that I have been urged to avoid bringing valuables into and onto the Company's facilities and the Company shall not be liable for the loss of, theft of, or damage to my personal property, including items left in lockers, bathrooms, or anywhere else in the Company's facilities. I acknowledge that no portion of any fees paid by me is in consideration for the safeguarding of valuables.

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