Form cover
Page 1 of 1

Red Light Therapy Waiver

RED LIGHT THERAPY USAGE WAIVER AND RELEASE OF LIABILITY
ACKNOWLEDGMENT OF RISKS
I understand that the use of red light therapy involves certain inherent risks, including but not limited to skin irritation, eye sensitivity, temporary redness, or other physical discomforts. I acknowledge that I have been advised to consult with a healthcare professional before using red light therapy, particularly if I have any medical conditions such as photosensitivity, skin disorders, pregnancy, or if 1am taking medications that may increase sensitivity to light.
HEALTH DISCLOSURE
I confirm that I do not have any medical conditions, illnesses, or injuries that would make the use of red-light therapy unsafe. I further confirm that I am not under the influence of alcohol, drugs, or any other substances that could impair my ability to safely participate in red light therapy sessions.
ASSUMPTION OF RISK AND VOLUNTARY PARTICIPATION
I voluntarily choose to participate in red light therapy and expressly assume all risks associated with its use, including but not limited to skin irritation, eye sensitivity, temporary redness, or any other physical discomforts or injuries that may arise. I acknowledge that while the facility has implemented reasonable safety measures to mitigate risks, it cannot guarantee the prevention of all unforeseen incidents or reactions. By participating in red light therapy, I accept full responsibility for my decision and agree to take necessary precautions, including using protective eyewear and following all instructions and guidelines provided.
LIABILITY WAIVER AND RELEASE
In consideration of being allowed to participate in red light therapy, I, on behalf of myself, my heirs, executors, and assigns, hereby release and discharge The Wellhaus, its owners, employees, agents, and affiliates from any and all claims, demands, or causes of action arising out of or related to my participation in red light therapy, except in cases of gross negligence or intentional misconduct.
ACKNOWLEDGMENT OF POLICIES
I agree to strictly adhere to all rules, policies, and guidelines provided by The Wellhaus, including but not limited to session time limits, hygiene requirements, and any instructions or directives issued by staff members. I acknowledge that these policies are designed to ensure the safety, comfort, and well-being of all participants. I further understand and accept that any failure, whether intentional or unintentional, to comply with these policies may result in the immediate suspension or permanent termination of my access to red light therapy and other related services, without any refund or recourse.
EMERGENCY PROCEDURES
In the event of discomfort or an emergency during a session, participants should immediately discontinue use and exit the therapy area. Notify a staff member or seek assistance if feeling unwell, experiencing dizziness, skin irritation, or any other unusual symptoms. If necessary, sit down, hydrate, and allow the body to cool or recover. For serious medical concerns, staff will assist in contacting emergency services. Participants are encouraged to familiarize themselves with the location of exits and first aid equipment prior to beginning any session.
RED LIGHT THERAPY AND THE ADA
Red light therapy rooms are typically designed with unique operational features, such as concentrated light delivery, that may not accommodate certain modifications without compromising the intended functionality or safety of the facility.
The nature of red light therapy involves inherent risks, such as exposure to concentrated light, which may pose additional hazards for individuals with certain medical conditions or disabilities. As such, you agree that some features may create complications if you have a disability.
The Wellhaus strives to make reasonable efforts to accommodate individuals with disabilities in other areas of our facility and services where possible. We encourage all guests to contact us with questions or concerns so we can explore available options to enhance their experience while maintaining safety and compliance with applicable regulations.

Full Name

*Full name is required. If the entire name is not typed, we will need the customer to fill out the form again correctly.*

Email

Phone Number

If you are pregnant, Red Light Therapy is not recommended over the full belly or breasts. If you are pregnant or nursing and still want to use the Red Light, you are doing so at your own risk. Our recommendation is to only use the Red Light from your belly and/or breasts.

If you are pregnant, Red Light Therapy is not recommended over the full belly or breasts. If you are pregnant or nursing and still want to use the Red Light, you are doing so at your own risk. Our recommendation is to only use the Red Light from your belly and/or breasts.
A
B

Indicate if you are photosensitive (light sensitivity), currently on oral, injectable, or topical steroids or have had recent botox injections, facial fillers, or other types of plastic surgery. Red Light Therapy may cause adverse reactions at these sites.

Indicate if you are photosensitive (light sensitivity), currently on oral, injectable, or topical steroids or have had recent botox injections, facial fillers, or other types of plastic surgery. Red Light Therapy may cause adverse reactions at these sites.
A
B

Indicate below if you have had recent LASIK eye surgery, a current diagnosis of cancer, or any other medical conditions for which your doctor has contraindicated the use of Red Light Therapy. * If you have a history of cancer or a medical condition you are not sure about, please consult with your physician prior to your session

Indicate below if you have had recent LASIK eye surgery, a current diagnosis of cancer, or any other medical conditions for which your doctor has contraindicated the use of Red Light Therapy. * If you have a history of cancer or a medical condition you are not sure about, please consult with your physician prior to your session
A
B
C

By signing below, I acknowledge that all the information within this form is true and I have read the complete waiver.

Signature

By signing below, I acknowledge that all the information within this form is true on behalf of a minor/minors.

Signature

Wellhaus Policies

Clients are expected to arrive on time for their scheduled appointments. If you arrive more than 10 minutes late, you may have to reschedule, as this will run into the next client's time. If you are late and don't wish to reschedule, please understand that your appointment time may be shortened to ensure the next client's service begins on time. You will still be charged full price for your scheduled service. If we are unable to reach you and you do not respond to our calls or messages regarding your appointment, your appointment may be marked as a no-show.

Clients are expected to arrive on time for their scheduled appointments. If you arrive more than 10 minutes late, you may have to reschedule, as this will run into the next client's time. If you are late and don't wish to reschedule, please understand that your appointment time may be shortened to ensure the next client's service begins on time. You will still be charged full price for your scheduled service. If we are unable to reach you and you do not respond to our calls or messages regarding your appointment, your appointment may be marked as a no-show.

Appointments must be cancelled or rescheduled a minimum of 4 hours before the scheduled appointment time. We understand life happens, and sometimes this is unavoidable, so your first instance will not be charged. If this occurs a second time, you will be charged 50% of the full amount of the service/s you booked. If it occurs a third time, you will be charged the full amount of the service/s. When you miss an appointment with us, we not only lose your business, but also the potential business of other clients who could have scheduled an appointment for the same time, as we keep a wait list.

Appointments must be cancelled or rescheduled a minimum of 4 hours before the scheduled appointment time. We understand life happens, and sometimes this is unavoidable, so your first instance will not be charged. If this occurs a second time, you will be charged 50% of the full amount of the service/s you booked. If it occurs a third time, you will be charged the full amount of the service/s. When you miss an appointment with us, we not only lose your business, but also the potential business of other clients who could have scheduled an appointment for the same time, as we keep a wait list.

The Wellhaus requires a card on file to book any appointment. This card will not be charged unless the client violates our cancellation policy. The client may choose to pay with an alternative method for any booked service. The Wellhaus will not share this information with any outside parties.

The Wellhaus requires a card on file to book any appointment. This card will not be charged unless the client violates our cancellation policy. The client may choose to pay with an alternative method for any booked service. The Wellhaus will not share this information with any outside parties.

To maintain a clean and comfortable environment for all guests, we ask the clients to refrain from smoking or vaping before or during their appointment. We ask that clients be respectful to our staff as well as to other clients while visiting the Wellhaus. We reserve the right to refuse service to any individual who shows blatant disrespect to our staff and clients.

To maintain a clean and comfortable environment for all guests, we ask the clients to refrain from smoking or vaping before or during their appointment. We ask that clients be respectful to our staff as well as to other clients while visiting the Wellhaus. We reserve the right to refuse service to any individual who shows blatant disrespect to our staff and clients.

By signing below, I agree to these policies set forth by The Wellhaus Salt & Sauna.

Signature