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    This can be found in your confirmation email


    Personal Information









    Contraindications

    Please answer all questions

    Have you experienced…

    Yes

    No

    Chest pains or palpitations? YesNo

    Unexplained breathlessness? YesNo

    Blackouts, faints or convulsions? YesNo

    Seizures, epilepsy or fits? YesNo

    Kidney or liver problems? YesNo

    Cancer or cancer treatment? YesNo

    Any circulatory problems/ disease? YesNo

    Blood clots in your legs / lungs? YesNo

    Asthma, bronchitis or pneumonia? YesNo

    High blood pressure (hypertension)? YesNo

    Claustrophobia? YesNo

    Urinary track infections? YesNo

    Neuropathy (loss of sensation)? YesNo

    Allergy or severe reaction to cold? YesNo

    Cough cold or flu in the last 2 weeks? YesNo

    Any infection within last 4 weeks? YesNo

    Child birth less than 8 weeks ago? YesNo

    Anaemia in the last 6 months? YesNo

    A heart attack in the last 6 months? YesNo

    Heart Bypass surgery in the last 6 months? YesNo

    Do you have…

    A pacemaker? YesNo

    Congestive Heart Failure (CHF)? YesNo

    Chronic Obstructive Pulmonary disease (COPD)? YesNo

    Raynaud’s disease (more than hands/feet sensitivity)? YesNo

    An intrathecal pump (pain pump)? YesNo

    Any open wound track or lesions? YesNo

    Any piercings? YesNo

    Do you...

    Wear contact lenses? YesNo

    Take any regular medication? YesNo

    Are you...

    Pregnant ? YesNo

    Safety Instructions

    Cryotherapy:

    1. You must wear cotton or wool socks and gloves provided by FYN, (and underwear in men) to avoid chilblain.

    2. Treatments are recommended to 3 minutes per session. Overexposure to the cold temperatures may cause chilblain;

    3. You should not remove personal protective equipment (PPE) at any time during your whole body cryotherapy session

    4. Wet or damp clothing cannot be worn at any time during the session. If you need dry clothing; please ask the receptionist or cryo technician for assistance

    5. You cannot enter the chamber with wet hair or moisture or oil on my skin

    6. You may notify the attendant to end the procedure at any time if you experience any problems or anxiety;

    7. Abnormal skin sensitivity to cold may be caused by certain foods, cosmetics, or medication, including but not limited to the following: Tranquillizers, High blood pressure medication;

    8. A person who is less than (18) years of age may not use whole body cryotherapy without parental consent;

    9. Do not touch any objects in the Cryo chamber with your unprotected skin.

    Floatation Tank:

    1.Assistance button located inside float tank (right side when floating) if needed.

    2.Please mind your step inside float room due to it being a wet room.

    3.Be aware that temperature of shower may be to hot or cold when stepping in.

    4.You are able to have float lid open when floating if you feel more comfortable.

    5.Please make staff aware if you have any open wounds before treatment start.

    5.Please make staff aware if you have any open wounds before treatment start.

    6.Use of float with hair extensions is not recommended.

    7.Shower before and after use of float.

    Waiver of Liability Hold, Release and Harmless Agreement:

    I understand and agree that:

    1. In consideration for using the cryotherapy device (Equipment), I hereby RELEASE, WAIVE, DISCHARGE, and NOT HOLD FYN or any of its employees (hereinafter referred to as RELEASEE) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any damage or injury that may be sustained by me, while using the equipment or due to the use of the equipment.

    2. I hereby confirm that no warranty or guarantee, or other assurance has been made to me covering the results of the cryotherapy process. I have been explained and understand the administration of the process, including possible adverse reactions, side effects, or other possible complications. It is understood that this CONSENT is being given in advance of any administration of the process, and is being given by me voluntarily to use the Equipment.

    3. I am fully aware of the risks connected with the use of the Equipment, and I am voluntarily participating in said Equipment usage, and entering the above named premises to engage in such usage. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS that may be engaged in such an activity.

    4. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEE from any costs that may incur due to the use of Equipment by me.

    5. It is my express intent that this Release and Hold Harmless Agreement shall bind the members of my family and shall be deemed as a RELEASE, WAIVER, AND DISCHARGE of the above named RELEASEE.

    6. The equipment is designed for fitness and 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 am NOT TO USE the equipment without my doctor’s written permission.

    7. I will comply with all instructions on the use of the cryotherapy device and that I am using these services at my own risk. I agree to use all sessions within the terms of the contract dates and understand that refunds are not given on unused portions of purchased packages.

    8. It is my express intent to inform FYN of any changes to my personal information

    By checking the box below, I acknowledge that (1) I have read, understand, and fully agree to the foregoing CONSENT, (2) the proposed indoor cryo process has been satisfactorily explained to me and I have all of the information I desire and (3), I hereby give my authorization and consent. This CONSENT shall stand as long as I use the Equipment at the location now and in the future.

    IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read and understand the foregoing Waiver of Liability and Hold Harmless Agreement, I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate, and complete consideration fully intending to be bound by same.

    I HAVE CAREFULLY READ THIS RELEASE INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A POTENTIAL CONFLICT BETWEEN MYSELF, AND MY HEIRS AND FYN, I VOLUNTARILY AGREE TO EACH OF THE TERMS AND PROVISIONS HEREIN AND SIGN THIS OF MY OWN FREE WILL.