Infrared Sauna Consent Form

Name*

First Last

Gender*

Address*

Street Address Address Line 2 Town Postcode

Telephone*

Date of Birth*

Emergency Contact*

First name Last name

Emergency Contact Telephone*

Doctors Name*

Surgery Name*

Surgery Address*

Street Address Address Line 2 Town Postcode

Occupation*

Weight*

Height*

Exercise*

Yes
No

Reasons for treatment*

Please describe levels of stress*

Do you smoke / vape?*

Yes
No

Do you drink alcohol?*

Yes
No

Do you take ant recreational drugs?*

Yes
No

Describe your recreational drug use

Are you taking any medications?*

Yes
No

Please list the medication you are currently taking

Have you been diagnosed with any medical condition?*

Yes
No

Please provide some details about your medical conditions

Have you had any operations or surgeries within the last five years?*

Yes
No

Please provide some details about your operations / surgeries

Have you ever been diagnosed with cancer?*

Yes
No

Please provide further details

Do you have any skin problems?*

Yes
No

Please provide further details

Do you have Constipation / Diarrhoea?*

Yes
No

Please provider further details

Have you ever used an infrared sauna before?*

please do not say yes if you have used a steam or traditional sauna this is only relating to Infrared.

Yes
No

I understand and agree to the following information, I also should NOT use the infrared sauna if:

I am pregnant*

Yes
No

I take Diuretics*

Yes
No

I take Barbiturates*

Yes
No

I take Beta Blockers*

Yes
No

I take Anticholinergics such as Amitriptyline*

Yes
No

Have been Diagnosed with any medical condition, that may limit or prevent your ability to sweat?*

Yes
No

Have been diagnosed with Anhidrosis?*

Yes
No

Have been diagnosed with Multiple Sclerosis?*

Yes
No

Have any central nervous system tumours?*

Yes
No

Have been diagnosed with Diabetes with Neuropathy?*

Yes
No

Am a Haemophiliacs/ Individuals prone to bleeding?*

Yes
No

Have a fever or any Cold / Flu / Covid?*

Yes
No

Have any condition that makes me have an Insensitivity to heat?*

Yes
No

At time of booking I am on my period/menstruating?*

Yes
No

Have chronically hot and swollen joints?*

Yes
No

Have unstable Angina?*

Yes
No

Have had a recent heart attack?*

Yes
No

Have severe arterial disease?*

Yes
No

Have any Cardiovascular conditions?*

Yes
No

Please provide further details

Have a pacemaker or defibrillator, which may be negatively affected by magnets used to assemble the infrared?*

Yes
No

Consent 1*

I have read the list of contraindications and advisements listed here and also on the website www.vibrantfeeling.co.uk and also understand that I have had an opportunity my emailing enquiries@vibrantfeeling.co.uk or contacting via telephone on 07850574009 to ask any questions to a staff member before booking .To my knowledge, I have no medical condition or Contraindication which would prelude me from having Infrared Sauna treatments. I consent to the Infrared sauna session and also confirm that I am at least 18 years of age .

I agree*

Consent 2*

I understand that the infrared sauna is for the purpose of detoxification and is not intended to take place of medical care or medications. I understand that the services I am receiving are not intended to treat any medical condition and I have done my own research on infra-red saunas. I understand that I take full responsibility for my own health and well-being. I acknowledge that the results of the infrared sauna used to vary, and that no guarantees a specific results are offered or implied. Vibrant feeling limited will not refund or credit any amount of money because of the clients unhappiness with their final results. I release Vibrant feeling ltd , its employees and technicians from all liability associated with using the Infrared sauna

I agree*

Signature*

Infrared Sauna Consent Form

Infrared Sauna Consent Form

I understand and agree to the following information, I also should NOT use the infrared sauna if:

What a Typical Appointment Includes

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