Wild Rose Healing House LLC Sauna Intake

Client Infrared Sauna Intake Form

*First Name
*Last Name
*Email
*Are you pregnant, breastfeeding or menstruating?	NO YES
*Are you taking any medications?	NO YES
*Diagnosed with any medical condition that may limit or prevent your ability to sweat?	NO YES
*Do you have unstable angina?	NO YES
*Do you have severe arterial disease?	NO YES
*Do you have a heart pacemaker or any other battery operated or electrical implant?	NO YES
*Do you currently have a fever, infection or injury?	NO YES
*Have you recently had high blood pressure, a heart attack or other cardiovascular problem?	NO YES
*Do you have a history of dizziness, fainting spells, heat sensitivity, narcolepsy or seizures?	NO YES
*Do you suffer from any bleeding disorders?	NO YES
*Are you currently on drugs, medication or alcohol?	NO YES
*Do you have hypertension / hypotension?	NO YES
*Do you have metal pins, rods or artificial joints?	NO YES
*Are you diabetic or obese?	NO YES
*Have you been diagnosed with any other medical condition?	NO YES
*IF SO PLEASE EXPLAIN:

***If you answered YES to any of these questions it is not recommended that you use the infrared sauna at this time. We suggest that you consult your physician or pharmacist to obtain a release form before proceeding with infrared sauna therapy. Please consult your physician if you are in doubt of your ability to use the far infrared for health reasons. ***

Appointment start times are prompt. It is recommended that you arrive 10-15 minutes prior to your appointment start time. If you are NEW clients you must complete and submit the Client Intake Form which can be done upon your arrival or in advance via our website. Arriving more than 15 minutes early may result in a wait, while arriving later than your appointment start time will result in a shortened appointment time. If you miss more than half of your scheduled treatment, your appointment will be treated as a late cancellation and service will not be conducted and you will be charge in accordance to the cancellation policy.

We adhere to our policies as a courtesy to other clients and our staff.

Terms & Conditions

Before my appointment I will screen myself for symptoms including fever and cough and will not come to my appointment if these symptoms are present, and will not reschedule until they clear up.
I hereby release and forever discharge Wild Rose and the employees that work there of any unfortunate and highly unlikely injury or illness that may occur as a result of your treatment.
Clients that arrive intoxicated / inebriated will be denied treatment, with client being liable for the full payment of scheduled treatment.
I will inform my therapist of any changes in my medical status.

Cancellation Policy

A 24-Hour notice for rescheduling or cancellation is required. Wild Rose reserves the right to charge the full treatment cost for reschedules and cancellations made with less than 24 hours notice. This includes appointments that are scheduled within 24 hours of the appointment time. If you cancel from within your online account and do NOT receive a text or email confirmation, you are required to contact us directly for guaranteed cancellation to ensure that you are not held liable for any charges. Cancellations must be communicated directly to the front desk. Email cancellations will not be accepted. If you have a contagious illness or skin condition, please adhere to our cancellation policy in order to not put our therapists at risk.

Late Policy

Appointment start times are prompt. It is recommended that you arrive 10-15 minutes prior to your appointment start time. If you are NEW clients you must complete and submit the Sauna Intake Form which can be done upon your arrival or in advance via our website. Arriving more than 15 minutes early may result in a wait, while arriving later than your appointment start time will result in a shortened appointment time. If you miss more than half of your scheduled treatment, your appointment will be treated as a late cancellation and service will not be conducted and you will be charge in accordance to the cancellation policy.

We adhere to our policies as a courtesy to other clients and our staff.

I acknowledge and accept the risks inherent in the use of the infrared sauna. I voluntarily assume the risk of injury, accident or death, which may arise from the use of the infrared sauna. I and any of my heirs, executors, representatives or assigns hereby release from all claims or liabilities for personal injury or property damages of any kind sustained while on the premises, during the use of the infrared sauna and from any advice provided by an employee or any representative. I agree that this release is in effect for all infrared sauna sessions. None of the information provided is intended to act as a substitute for medical advice, nor does it involve the diagnosis, prognosis, or prescription of remedies for the treatment or prevention of any disease or ailment. I certify that everything on this form is true and correct to the best of my knowledge. I also understand that the infrared sauna is not intended to diagnose, treat, cure, or prevent any disease or ailment.

By checking this box I acknowledge and represent that I have read everything above, understand it and sign it voluntarily as my own free act and deed, including without limitation the Release of Liability contained in this document. I also agree to the terms and conditions, cancellation policy and late policy