Localized Cryotherapy Consent & Release Form

 

CryoNook LLC

 

Please read this document carefully. By signing, you acknowledge and agree to the terms and conditions set forth below for localized cryotherapy sessions.

Client Information

 

• Full Name: __________________________________________________
• Date of Birth: ___________________ Phone: _____________________
• Address: ____________________________________________________
• Email: _______________________________________________________

1. Nature of Procedure & Informed Consent

 

I understand that localized cryotherapy is a non-surgical procedure that applies extremely low temperatures to specific areas of the body for therapeutic purposes. While generally considered safe, I acknowledge that individual responses vary and involve certain risks.

2. Safety Requirements & Risks

 

• Skin Preparation: I certify that my skin is completely dry and free of any creams, lotions, oils, or moisturizers.
• Risk of Skin Burn: I understand there is a risk of skin burns or frostbite if precautions are not followed or if I have sensitive skin. I agree to follow all safety instructions provided by the technician.
• Pre-existing Conditions: I will inform the technician of any allergies, skin conditions, Raynaud’s Syndrome, or recent injuries. It is my responsibility to notify the technician of any changes in my health before each session.
• Session Duration: I agree to adhere to the recommended session time (typically 3–7 minutes) as advised by the technician.

 

3. Medical Disclaimers

 

• Not a Cure: I understand that localized cryotherapy is a treatment, not a cure for medical conditions. Results are not guaranteed.
• Consultation Recommended: This session is not a substitute for a medical evaluation. CryoNook LLC recommends consulting a physician (PCP) prior localized Cryotherapy for conditions such as hypertension, diabetes, circulatory problems, varicose veins, muscle injuries, hernias, or pregnancy.

 

4. Post-Treatment Care

 

I agree to refrain from exposure to extreme heat (hot showers, saunas, or sunbathing) for at least one hour following my session.

 

5. Release of Liability

 

I hereby release and discharge CryoNook LLC, its owners, employees, and affiliates from any and all claims, damages, liabilities, or expenses arising from these sessions. I understand that CryoNook LLC does not assume liability for accidents or injuries occurring on the premises or as a result of the treatment.

 

6. Travel & Distance Fee

 

I acknowledge that a travel fee applies to Mobile Services as disclosed during booking. I agree to pay the total amount shown, which includes travel costs only when applicable to my selected service type.

 

Acknowledgment & Signature

 

I have had the opportunity to ask questions, and they have been answered to my satisfaction. I acknowledge that I have read this document in its entirety and voluntarily assume the risks described.

 

Client Signature: __________________________________ Date: ___________

Parent/Guardian Signature: ________________________ Date: ___________
(Required if client is under 18 years of age)