Infrared Sauna Informed Consent Form
1224 2nd Street NE, 2nd Floor
Minneapolis, MN 55413
ADVISEMENTS & CONTRAINDICATIONS
Any of the below described contraindications will require you to use discretion for your own wellbeing. Severe medical conditions or pregnancy will require a note of authorization from your doctor prior to the use of the infrared sauna.
Medications – Diuretics, barbiturates and beta-blockers may impair the body’s natural heat loss mechanisms. Anticholinergics such as amitryptaline may inhibit sweating and can predispose individuals to heat rash or to a lesser extent heat stroke. Some over-the-counter drugs, such as antihistamines, may also cause the body to be more prone to heat stroke.
Pregnancy/Breast Feeding – Pregnant women should consult a physician before using an infrared sauna. A doctor’s consent is required. If breast-feeding, do not use the infrared sauna. A detoxification process will produce the expelled toxins into your breast milk.
Menstruation – Heating of the low back area of women during the menstrual period may temporarily increase their menstrual flow.
Elderly – The body must be able to activate its natural cooling processes in order to maintain core body temperature. As we mature, our bodies naturally lose this capability. Guests over the age of 70 will be permitted for infrared sauna use, however, at a lower temperature.
Cardiovascular Conditions – Individuals with cardiovascular conditions or problems (hypertension/hypotension), congestive heart failure, impaired coronary circulation, or those who are taking medications that may affect blood pressure should exercise caution when exposed to prolonged heat. Heat stress increases cardiac output and blood flow in an effort to transfer internal body heat to the outside environment via the skin (perspiration) and respiratory system. This takes place primarily due to major changes in the heart rate, which has the potential to increase by thirty (30) beats per minute for each degree increase in core body temperature.
Alcohol/Alcohol Abuse – Contrary to popular belief, it is not advisable to attempt to “sweat out” a hangover. Alcohol intoxication decreases a person’s judgment; therefore, they may not realize when the body has a negative reaction to high heat. Alcohol also increases the heart rate, which may be further increased by heat stress. Guests who appear intoxicated or inform us of alcohol consumption prior to use of the sauna will forfeit their scheduled appointment and no refund or credit will be issued.
Chronic Conditions/Diseases Associated with Reduced Ability to Sweat or Perspire – Multiple sclerosis, central nervous system tumors, and diabetes with neuropathy are conditions that are associated with impaired sweating.
Hemophiliacs/Individuals Prone to Bleeding – The use of infrared saunas should be avoided by anyone who is predisposed to bleeding.
Fever – An individual who has a fever should not use an infrared sauna until the fever subsides.
Insensitivity to Heat – An individual with insensitivity to heat should not use an infrared sauna.
Joint Injury – If you have a recent (acute) joint injury, it should not be heated for the first 48 hours after an injury or until the swollen symptoms subside. If you have a joint or joints that are chronically hot and swollen, these joints may respond poorly to vigorous heating of any kind.
Implants – Metal pins, rods, artificial joints or other surgical implants generally reflect infrared waves and thus are not heated by this system. Nevertheless, you should consult your physician prior to using an infrared sauna.
Pacemakers/Defibrillators – The magnets used to assemble infrared saunas can interrupt the pacing and inhibit the output of pacemakers. Please discuss with your doctor the possible risks this may cause.
In the rare event that you experience pain and/or discomfort, immediately discontinue sauna use and exit the sauna.
Sauna Rules & Responsibilities
At NE Wellness, we strive to create a safe, nurturing and healing space that is accessible to everyone in our community. The saunas are resources for our community that require the respect of everyone using them. To ensure your safety and wellbeing, please adhere to the following rules:
- NO OILS, LOTIONS OR CREAMS OF ANY KIND ARE ALLOWED IN THE SAUNA. IF THE SAUNA IS LEFT WITH STAINS AFTER YOUR SESSION, YOU WILL BE CHARGED A $50 CLEANING FEE.
- NO FOOD IS ALLOWED INSIDE THE SAUNA. PLEASE DRINK PLENTY OF WATER DURING YOUR SAUNA SESSION.
- FOR YOUR OWN SAFETY, YOU MAY NOT USE THE SAUNA IF YOU ARE UNDER THE INFLUENCE OF DRUGS OR ALCOHOL.
- WHEN YOUR SESSION IS COMPLETE, PLEASE SPRAY THE WOOD IN THE SAUNA WITH THE SAUNA CLEANER AND WIPE DOWN THE AREA. WIPE FINGERPRINTS OFF THE GLASS WITH VINEGAR.
- THE SAUNA IS FOR QUIET CONTEMPLATION AND RELAXATION. ANY OTHER ACTIVITY IS NOT ALLOWED. THIS IS A NON-SEXUAL THERAPEUTIC SAUNA.
- NE WELLNESS RESERVES THE RIGHT TO REFUSE USE OF THE SAUNA IF PATIENTS DO NOT FOLLOW THE ABOVE RULES.
CANCELLATION POLICY For All Services.
NE Wellness makes every attempt to make collaborative health care, Acupuncture and Chinese medicine as available to as many people as possible, at the most affordable rates.
In respect for our intention to offer high quality health care at affordable prices, we ask for 24 hours notice in advance of an appointment if it is necessary to cancel or reschedule an appointment.
All appointments that are rescheduled or cancelled with less than 24-hour advance notice, and appointments missed without notice, will be charged a fee equal to 50% the full appointment value. If appointments have been purchased in a package, the missed, cancelled, or rescheduled appointment will be deducted from the number of remaining appointments in that package.
|By signing this I am acknowledging that I have had full opportunity to read and consider the contents of this office’s Privacy Practices/Terms &Policies, which can be found at newellnessmpls.com/terms-policies/. I further acknowledge and understand that, by signing this Patient Intake Form that I am giving my consent for this office’s use and disclosure of my protected health information to carry out treatment, payment activities and health care options, as outlined in the Notice of Privacy Practices disclosure in the link above.
Infrared Sauna Informed Consent
I have read the advisements and contraindications for infrared sauna use.
I have no conflicts for use as described in the advisements and contraindications, or I have provided a doctor’s release authorizing use.
I consent to the infrared sauna session, and confirm that I am at least 18 years of age.
I understand that this is not intended to take place of medical care or medications. I clearly confirm that I have read the advisements and contraindications, and that I do not have any contraindications to the infrared sauna. I understand that I take full responsibility for my own health and wellbeing.
I understand that the services I am receiving are not intended to treat any medical condition or take the place of medical care or medications. I RELEASE the business, its employees and technicians from all liability associated with using the infrared sauna.
You are advised to see your physician about the problem for which you have come here to be treated.