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Client Release and Informed Consent Form: Heat and Massage

Thank You!

It is important that you inform our staff if you have any of the conditions listed below under "contraindications" for use of the Cocoon Fitness Pod System" before undertaking sauna (heat) and/or vibratory massage treatments.  The Cocoon Fitness Pod System is not a medical device and it is not intended to diagnose, treat, cure or prevent any disease.

It is our intent to keep you as well informed about our services as possible.  Please read the following information andf acknowledge that you understand and accept all provisions by signing the form.

I understand that Power Yoga Canada Sudbury ("the facility") intends to utilize the Cocoon Fitness Pod System to provide me with sauna (heat) and vibratory massage services for the promotion of relaxation, general wellness and fitness.  I hereby give my consent to the facility and its staff to provide wellness services for these purposes.  I further understand that members of the staff do not diagnose illness or disease or any other physical or mental disorder.  I understand that sauna (heat) and vibratory massage therapies are not substitutes for medical examinations or treatments.  I have been advised to consult with my personal physician for any ailments that I may be experiencing.  I acknowledge that no assurance or guarantee has been provided to me as to the results of services provided by the facility.  I hereby agree that the facility will not be liable for any injury to me resulting from my use of the Cocoon Fitness Pod system and I hereby forever release the facility from any and all claims, demands, damages or causes of action resulting from said use.

Contraindication for use of the Cocoon Fitness Pod System:

Use of the Cocoon Fitness Pod System is NOT RECOMMENDED for individuals with the following conditions:

1. Epilepsy

2. Active cancer

3. Broken bones or slipped disc

4. Infectious/contagious skin conditions; skin lesions, abrasions and/or areas of inflammation/persistent erythema

5. Intoxication

6. Outfitted with pacemakers or defibrillators

7. Individuals running a fever or insensitive to heat (i.e. erythema ab igne)

Individuals with the following conditions are advised to obtain physical consent before using the Cocoon Fitness Pod

1. Pregnancy or lactating

2. Heart disease and/or other cardiovascular conditions

3. Diabetes

4. Using medications such as diuretics, barbiturates, anticholinergics, and/or beta blockers

5. Hemophiliacs/individuals prone to bleeding

6. Individuals with implants (metal, breast, etc)

7. in poor health

I understand that the staff must be made fully aware of my existing medical conditions, if any, I also understand that prolonged exposure to heat can lead to dry skin.  I have been advised that it is important to hydrate before and after heat sessions to insure against dehydration and that for high heat sessions I should initially use a comfortable heat level and gradually increase the heat level as my body acclimates or adjusts to the higher cabinet temperatures.

The information I have provided is true and complete to the best of my knowledge.  I have read this informed Consent and Release Form and I have had the opportunity to ask questions about the contents and my treatment.  By signing this informed Consent and Release Form, I affirm my consent to treatment and intend this consent to cover the services discussed with me and such additional services as requested by me from time to time.  I understand that at any time I may withdraw my consent and further services will be discontinued.

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