Client Information and Consent form - Free Your Chi by cuiliqing


									                                 Far Infrared Sauna
                        Client Information and consent form

Far infrared rays are a harmless, invisible part of the light spectrum, however there are certain
medical conditions that need to be considered before using a sauna or heat therapy.

We value our clients and their safety is of the utmost concern. We offer the service of Far Infrared
Saunas for your relaxation and enjoyment.

Please read the following contraindications for your safety to ensure that you get the maximum
benefit and enjoyment from you session.

Contraindicated Medical Conditions:

People with certain conditions however should avoid infrared sauna therapy due to adverse
responses to increases in body temperature or circulation.

Avoid infrared therapy if you have the following conditions:

Adrenal suppression or uncontrolled thyroid dysfunction

Systemic lupus erythematosis

Haemophilia (or those predisposed to haemorrhage)

Acute thrombosis (blood clots)

Acute infections/fever (wait till the fever subsides)

Acute injury (within 48-72hrs)

Unstable cardiac conditions

Pregnancy or suspicion of pregnancy

Multiple Sclerosis, Cystic Fibrosis, Central Nervous System Tumors and Diabetes with Neuropathy
are conditions that are associated with impaired sweating

Insensitivity to heat

Have consumed any alcohol or suffer from alcohol abuse

Prior Medical Clearance needs to be obtained before using infrared saunas for any of the
following conditions;

Chronic cardiac conditions are not a contraindication but medical clearance should be obtained
before trialing infrared therapy.
Individuals who are using prescription drugs should seek the advice of their personal physician or
a pharmacist for possible changes in the drugs effect when the body is exposed to infrared waves
or elevated body temperature. Diuretics, barbiturates and beta-blockers may impair the body’s
natural heat loss mechanisms. Anticholinergics such as amitryptaline and psychiatric drugs 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.

Any other medical conditions you are unsure about, and if you are on prescription medication, just
check with your doctor first.

Saunas & Children
The core body temperature of children rises much faster than adults. This occurs due to a higher
metabolic rate per body mass, limited circulatory adaptation to increased cardiac demands and the
inability to regulate body temperature by sweating. When using with a child, operate at a lower
temperature and for no more than 15 minutes at a time.

Saunas & The Elderly
The ability to maintain core body temperature decreases with age. This is primarily due to
circulatory conditions and decreased sweat gland function. The body must be able to activate its
natural cooling processes in order to maintain core body temperature. When using with the
elderly, operate at a lower temperature and for no more than 15 minutes at a time.

Saunas & Menstruation
Heating of the low back area of women during the menstrual period may temporarily increase their
menstrual flow.

Saunas & Implants
Metal pins, rods, artificial joints or any other surgical implants generally reflect infrared waves and
thus are not heated by this system. Practising gentle mobility exercises in the warm sauna can be
an excellent way to recover movement after joint replacements. It is still advisable just to clear
this with your surgeon before proceeding.
Silicone implants may be warmed by infrared rays but do not usually melt until reaching
temperatures over 200degrees so there should be no problems.

Nevertheless, you should consult your physician prior to using an infrared sauna.

I, ______________________________, have read the above contraindications and understand

that the Far Infrared Sauna is for relaxation and enjoyment purposes and not for the diagnosis or
treatment of any disease.
Although there are many benefits to sauna and heat therapy I have honestly disclosed any issues I
have that would lead to the contrary. I have informed the staff of Free Your Chi Health and
Wellness Studio of any issues that I may have that would otherwise interfere with the safe use of
the Far Infrared Sauna including any medical conditions or disease.
I understand that it is my responsibility to notify my therapist of any changes in my health or
medical history that may affect the safe use of the Far Infrared Sauna.

____________________________________________                              ____________________

Signature of Client/Guardian                                                      Date

To top