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Wavier & Liability Release Form

Please fill out the following form.

I acknowledge that I am voluntarily participating in wellness services provided by Recovery Rx LLC, doing business as EmergeCryo. These services may include but are not limited to cold plunge, infrared sauna, localized cryotherapy, Emsculpt, Cryo Bodysculpting, CryoFacial red light therapy, PEMF (Pulsed Electromagnetic Field) therapy and compression (collectively referred to as "Services"). I understand and agree to the following:


1. Contraindications and Risks: I acknowledge that each of the Services provided by Recovery Rx LLC may have contraindications and associated risks. These contraindications and risks include, but are not limited to:


  • Cold Plunge: Contraindicated for individuals with heart conditions, hypertension, or respiratory issues.


  • Infrared Sauna: Contraindicated for individuals with cardiovascular conditions, insensitivity to heat or conditions that prohibit ability to sweat, pregnancy, pacemaker or defibrillator, current fever or illness.


  • Localized Cryotherapy: Contraindicated for individuals with cold allergies, certain skin conditions, or circulatory issues.


  • Emsculpt: Contraindicated for individuals with metal implants, metal rods, pins, plates, orthopedic implants/joints, or during pregnancy.


  • Cryo BodySculpting: Contraindicated for individuals with kidney disease, active cancer, untreated abdominal hernia, severe diabetes, varicose veins or pregnant ladies.


  • CryoFacial: Contraindicated for individuals who have been treated with Botox or Fillers within 4 weeks prior to treatment.


  • Red Light Therapy: Contraindicated for individuals with photosensitivity or epilepsy.


  • PEMF Therapy: Contraindicated for individuals with pacemakers, cochlear implants, active cancer or pregnancy.


  • Compression Therapy: Contraindicated for individuals with acute deep vein thrombosis, severe arterial insufficiency, or infection.


2. Photo Consent: I grant permission for Recovery Rx to take and use photographs of me for the purpose of documenting my progress. I understand that these photographs may be used for internal assessment and evaluation. I release Recovery Rx LLC from any claims or liabilities related to the use of these images.


3. No Guarantee of Outcome: I understand and acknowledge that Recovery Rx LLC does not guarantee any specific outcomes or results from participating in the Services.


4. Post Care Instructions: I agree to abide by any post-care instructions provided by Recovery Rx LLC staff following the Services.


5. Personal Responsibility: I understand that it is my responsibility to inform Recovery Rx LLC staff of any medical conditions, medications, or other factors that may affect my ability to safely participate in the Services. I agree to disclose this information truthfully and completely. I agree to inform Recovery Rx LLC of any physical or mental discomfort during my session and terminate treatment immediately.


6. Release of Liability: In consideration for being permitted to participate in the Services, I hereby waive, release, and discharge Recovery Rx LLC, its owners, employees, and agents from any and all claims, liabilities, demands, actions, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, whether caused by the negligence of Recovery Rx LLC or otherwise, while participating in the

Services.


7. Indemnification: I agree to indemnify and hold harmless Recovery Rx LLC, its owners, employees, and agents from and against any and all claims, liabilities, demands, actions, and causes of action brought by third parties, arising out of or related to my participation in the

Services.


8. Knowing and Voluntary Execution: I have carefully read this waiver and fully understand its contents. I am aware that by signing this waiver, I am waiving certain legal rights I or my heirs, next of kin, executors, administrators, and assigns may have against Recovery Rx LLC. I

voluntarily agree to all terms and conditions stated herein.

Birthday
Date and time
:

For Minor (under 18):

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