FOR SERVICES RENDERED AT ALL LOCATIONS
Consent, Release of Liability and Waiver
This is an important legal document. It explains the risks you are assuming. It is critical that you read and understand it completely before you sign below.
I, the undersigned individual, acknowledge that by signing this Consent, Release of Liability and Waiver I am confirming that I recognize that there may be a high degree of risk associated with using HigherDOSE equipment and/or facilities, being exposed to full-spectrum infrared rays, and participating in and/or receiving sessions, programs, therapies, saunas, exercise and/or treatments at/in the HigherDOSE facilities (hereinafter “Services”), and that the Services may be hazardous to my health. I expressly agree to assume all risk associated therewith and agree to forever waive any and all claims and legal rights which I may have whatsoever, to the extent permitted by law, in connection with my use of the Services.
I acknowledge that the Services do not constitute medical treatment or diagnosis and that HigherDOSE associates are not health care practitioners. The use of the word “treatment” in the context of HigherDOSE services does not refer to medical treatment. The only exception to the foregoing is intravenous hydration available at some HigherDOSE locations, the provision of which is the sole responsibility of IV Medical New York, PLLC (“ivee”) and not HigherDOSE.
I understand that before using any Services that I should consult my physician and in the event my health condition changes while I am using the Services, I agree to consult with my physician prior to resuming use of the Services. I understand and agree that all suggestions and/or instruction made by HigherDOSE associates concerning exercise, nutrition or any other Service are neither diagnostic nor prescriptive, that I should verify the same with my physician, and that I will evaluate such instructions and/or suggestions independently. I understand that HigherDOSE will not inquire whether I require medical clearance before using the Services.
I understand that I am responsible for discussing any questions or concerns that I may have concerning my health conditions (if any), or concerning the Services in any way, prior to and throughout the Services with a HigherDOSE associate. Should I experience any pain or discomfort during the Services, or should any health-related symptoms occur, I will immediately cease my participation in the Services and inform a HigherDOSE associate, of any such symptoms, and I will seek immediate medical attention from a doctor of my own choosing.
By voluntarily choosing to participate in/receive the Services, I warrant that to the best of my knowledge I am not pregnant and I do not have any disability, impairment, ailment or other condition that may prevent me from participating in/receiving such Services. I affirm that I have stated all my known medical conditions, and answered all questions honestly.
I hereby confirm that no warranty or guaranty or other assurance has been made to me regarding the results of the infrared sauna process or program, or any of the Services.
I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident, and/or illness during the Services, but I acknowledge that HigherDOSE has no duty to provide medical treatment to me. I hereby authorize HigherDOSE to call for medical assistance for me in the event of an emergency. I further agree to be responsible for all costs and expenses associated with any such medical care and/or related transport.
Consequently, in light of the foregoing and in consideration for participating in/receiving the Services, I hereby, on behalf of myself and my heirs, beneficiaries, next of kin and assigns, forever waive, irrevocably release, discharge, and agree to indemnify, defend and hold harmless (i) HigherDOSE LLC (and its parent corporation(s), subsidiaries, affiliated corporations); and (ii) each of their respective officers, directors, shareholders, employees, agents, representatives and successors, and forever waive and discharge in advance any and all claims, liabilities, or damages for personal injuries, demands, causes of action (including, without limitation, negligence) or any other claims of any nature whatsoever, including, without limitation, any losses for property damage, personal injury or death, that I may experience directly or indirectly from participating in/receiving any of the Services, including Services provided by ivee. It is my express intent that this Consent, Release of Liability and Waiver shall bind the members of my family, my personal representatives, heirs, beneficiaries and next of kin and my and their assigns, and shall be effective to the greatest extent permitted in accordance with the laws of the State of New York.
This Consent, Release of Liability and Waiver shall be effective for as long as I participate in/receive the Services and use the facilities at this location now and in the future, including participation in other programs offered by HigherDOSE.
I represent and acknowledge that I have read and understand this Consent, Release of Liability and Waiver and understand that my voluntary execution evidences my agreement to the terms, provisions, waivers, and releases as set forth above. I acknowledge that I have had an opportunity to review this Consent, Release of Liability and Waiver with advisors of my choosing prior to participation in/receipt of any of the Services. The invalidity, in whole or in part, of any portion of the above paragraphs will not affect the remainder of this form.
FOR CRYO FACIAL SERVICES
Additional HigherDOSE Consent, Release of Liability and Waiver
Do NOT use CRYO Facial services if you have or may have any of the following medical conditions:
□ Acute infections
□ Acute kidney and urinary tract diseases
□ Acute/recent cerebrovascular accident
□ Acute/recent myocardial infarction
□ Bleeding disorders
□ Cold activated asthma
□ Cold allergies
□ Cold-activated asthma
□ Peripheral arterial occlusive disease
□ Peripheral Vascular Disease (PVD)
□ Raynaud's Disease
□ Severe anemia
□ Severe Hypertension (BP> 180/100)
□ Symptomatic lung disorders
□ Uncontrolled seizures
□ Unfit for exercise
□ Unstable angina pectoris
PLEASE ALERT HIGHERDOSE STAFF IF THERE ARE ANY CHANGES TO YOUR MEDICAL CONDITION AND/OR TREATMENT IN SUBSEQUENT VISITS.
I understand that the CRYO Facial services being rendered are designed for appearance enhancing use only by persons in good general health. I have been advised that if I suffer from any medical condition or illness whatsoever I should seek my doctor’s written permission before receiving the services. I understand that if I suffer from any medical condition listed above I should not receive the services under any circumstance.