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Infrared Sauna

& Red Light Therapy Waiver

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2026 Sauna & Red Light Therapy Waiver

Complete this form if:

  1. You are not a member and you have booked an infrared sauna session or red light therapy session. 

  2. You are not a member and you are redeeming a sauna voucher win.

  3. You are  a member and you have added on the red light therapy membership.

  4. You are not a member and you have purchased a single or multipack of radiant healing sessions. 

2026 Infrared Sauna & Red Light Therapy

Intake & Release Form

Personal Information

Birthday
Month
Day
Year
Multi-line address

Emergency Contact

Health Information

Current Health Status
Good
Fair
Poor
Medical History (Check any that apply and provide details if necessary)
Allergies (Include medication allergies)
No known allergies
Yes*

Infrared Sauna Use

Previous experience with infrared sauna
None
Some
Frequent
Primary reason for using the infrared sauna
Frequency of intended sauna use
One-time
Weekly
Monthly

Red Light Therapy Use

Previous experience with Red Light Therapy
None
Some
Frequent
Frequency of intended Red Light Therapy use
One-time
Weekly
Monthly

CONSENT AND AGREEMENT

Acknowledgment of Risks and Waiver of Liability

Health problems that are contraindicated for Infrared Sauna Use:

  • Pregnancy

  • Cardiovascular Issues (Like Heart Failure, Hypertension)

  • Fever/Infection

  • Acute Joint Injuries

  • Bleeding Disorders

  • Impaired Sweating (MS, Diabetes With Neuropathy)

  • Being Under the Influence of Alcohol/Drugs

    **If you have any of the above health related problems, you are not a good candidate for infrared sauna use and will need to be cleared by a medical professional before being able to participate.

Health problems that are contraindicated for Red Light Therapy :

  • Malignant Cancers

  • Eye Diseases

  • Recent Burns

  • Light Sensitivity

  • Hyperthyroidism

  • Fever/Infection

  • Epilepsy

  • Systemic Lupus Erythematosus (SLE)

  • Pregnancy

  • Severe Blood Loss/Bleeding

  • Heart Disease or Pacemaker

  • Use of Photosensitizing Medications

    **If you have any of the above health related problems, you are not a good candidate for red light therapy and will need to be cleared by a medical professional before being able to participate.

Risk Acknowledgment: I understand that using an infrared sauna and/or red light therapy may pose health risks, especially for individuals with certain medical conditions. I have informed DW staff of all relevant health issues and have consulted a healthcare professional when necessary before deciding to use the sauna and/or red light therapy.


Assumption of Risk (Infrared Sauna): I acknowledge and voluntarily assume the risks associated with sauna use, understanding that there is a possibility of adverse physical effects, including but not limited to dehydration, fainting, heat stroke, or heart failure.


Assumption of Risk (Red Light Therapy): I acknowledge and voluntarily assume the risks associated with red light therapy use, understanding that there is a possibility of adverse physical effects, including but not limited to eye damage, skin irritation, and burns.


Waiver of Liability: I hereby agree to release, waive, discharge, and covenant not to sue the facility, its officers, employees, or agents from any and all liabilities arising from bodily injury, accidents, or death that may occur as a result of my participation in sauna and/or red light therapy activities. This release extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown.


Emergency Procedures: I agree to immediately report any feelings of discomfort, dizziness, or other concerning symptoms to the staff and cease using the sauna and/or red light therapy if advised by staff or if such symptoms occur.


Privacy Policy

Confidentiality Commitment: I acknowledge that the sauna and red light therapy facility commits to maintaining the confidentiality and privacy of all personal and health information provided in this form. Information will only be used to evaluate suitability for sauna and/or red light therapy use and manage my experiences appropriately.


Data Usage: I consent to the collection, use, and, where necessary, the disclosure of my personal information as needed for the provision of sauna and/or red light therapy services. This may include sharing information with healthcare professionals under circumstances that require medical intervention.


Rights to Access and Correction: I understand that I have the right to request access to my personal records held by the facility and can request corrections to any inaccuracies in my personal data.


Security Measures: I acknowledge that the facility implements appropriate security measures to protect my personal data from unauthorized access, alteration, or destruction.

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Date and time
Month
Day
Year
Time
HoursMinutes

Destination Wellness

31 W Church Street

Newark, OH 43055

(740) 280-2031

lcdestinationwellness@gmail.com

www.lcsdestinationwellness.com

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