INFRARED SAUNA CONSENT AND RELEASE FORM Name: ________________________________________________________ Address: ______________________________________________________ DOB: ___________________ Phone/Cell Phone: ____________________ Email: ________________________________________________________ Emergency Contact: _____________________________________________ Physician: _____________________________________________________ Have you ever used an Infrared Sauna before? ☐Yes ☐No Please, list any allergies you may have: ____________________________________________________________________________ Please list any medications you are currently taking: ____________________________________________________________________________ Is there anything else we should know? ____________________________________________________________________________ * If you answered YES to any of the above questions it is not recommended that you use the infrared sauna at this time. You need to get a consent form from your physician in order to proceed with infrared sauna therapy. BEFORE YOUR SESSION: • Drink plenty of water before and during your session. After the session drink water with electrolytes. • It is helpful to have food/snack 1–2 hours before your session. You can even bring an apple or banana for after the session. • If you experience pain and/or discomfort, immediately discontinue and exit the sauna. • If you are on any medications, consult with your doctor before using the infrared sauna. • Do not use drugs, tobacco, or alcohol prior to or after the sauna session. • No one under the age of 18 is permitted in the far infrared sauna unless accompanied with a guardian. • Exit the sauna if you feel light-headed, dizzy, heat exhausted, or unwell. Are you pregnant? ☐Yes ☐No Do you currently have a fever, infection or injury? ☐Yes ☐No Have you recently had high blood pressure, a heart attack or other cardiovascular problem? ☐Yes ☐No Do you have a history of dizziness, fainting spells, heat sensitivity, narcolepsy or seizures? ☐Yes ☐No Do you have a heart pacemaker or any other battery operated or electrical implant? ☐Yes ☐No www.arawiseman.com 416.867.8155