Massage Chair Waiver
& Release of Liability
By e-signing this waiver, I hereby acknowledge and agree to the following terms and conditions in connection with my use of the automatic massage chairs.
Voluntary Participation: I voluntarily choose to participate in the use of automatic massage chairs provided by Blissed.
Assumption of Risk: I understand and acknowledge that the use of automatic massage chairs involves certain inherent risks, including but not limited to the risk of injury or aggravation of pre-existing medical conditions.
Massage Chair Contraindications: If you have any medical conditions or any of the conditions listed below:
Pacemakers-The electromagnetic function of the chair could interfere with a pacemaker.
Hypertension (Consult with your Provider before scheduling).
If you have an infection or are sick.
Open Wounds/Sores/Inflammation of the Skin/Irritation of the Skin/Rashes.
Blood Clots or if you have a history of them.
Varicose Veins (Consult with your Provider before scheduling).
Pregnancy (Consult with your Provider before scheduling).
Osteoporosis/Recent Broken Bones/Fractures/Sprains/Bruises.
* Warning – Do not leave the massage chair unattended during use. Improper use or improper adjustments of the massage chair can cause serious bodily injury.
Health Considerations: I hereby certify that I am 18 years of age or over, weigh less than 260lbs and in good physical condition, and have no medical conditions that would prevent my safe use of the automatic massage chairs. I understand that it is my full responsibility to consult with a medical professional before using the massage chairs if I have any concerns about my health or fitness.
* If I am under the age of 18 a parent or legal guardian must review and sign this waiver on my behalf prior to my participation.
Release of Liability: I on behalf of myself and my heirs, executors, administrators, and assigns, hereby release and discharge Blissed, its owners, employees, agents, and representatives from any and all claims, liabilities, demands, actions, causes of action, costs, and expenses, whether at law or in equity, known or unknown, arising out of or in connection with my use of the automatic massage chairs.
Waiver of Claims: I waive any claims, demands, or causes of action that I may have against Blissed as a result of my use of the automatic massage chairs.
I have read this waiver and release of liability, fully understand its terms, and signed it voluntarily. I acknowledge that this document shall be binding upon me, my heirs, executors, administrators, and assigns.
Sound Lounge Waiver
& Release of Liability
Sound Healing, Sound Therapy, Sound Meditation, or Sound Energy Healing with the Sound Lounge.
The Sound Lounge is a fully immersive and therapeutic sound experience created to accelerate entry into deep meditative states. With the intention and use of sound and vibration to restore balance and promote deep relaxation.
As a Sound Therapy Practitioner and Reiki Practitioner, I am not a licensed health professional. As such I will not diagnose, perform medical treatment, prescribe substances, or interfere with treatment from licensed medical professionals. The services I offer are considered complementary to traditional Western medicine.
Our Sound Lounge Sessions are 20/30 minutes or 45/60 minutes. During this time, you will please quiet your phones, get comfortable, and have a seat, feel free to use a weighted blanket, take off your shoes, place headphones, and choose a meditation from our Sensory Lounge soundtracks. Take a deep breath, inhale, exhale, and enjoy! Sound waves will be sent to the ear through headphones and vibrations on the Sound Lounge to the body. The sounds from the Sound Lounge can give off some very high or very low-pitched sounds. If you have reason to believe these sounds can cause you any discomfort, injury, or pain, please consult with your Primary Care Provider for approval before scheduling.
Please dress comfortably in comfortable clothing. Please do not wear any bug spray or lotions. No belts or zippers. Wear socks. Please remove the jewelry or leave it at home.
Sound Lounge Contraindications: If you have any medical conditions and/or any of the conditions listed:
Pacemakers-Magnets in the transducers of the sound lounge could interfere with a pacemaker.
Hypotension ( Contact your Provider before scheduling)
Severe or Chronic Mental Illness
If you have an Infection and or are sick.
Pacemaker/Defibrillator/Implantable Devices, Stent/Shunt
Deep Brain Stimulation/Other Implanted Electrical Device
DVT – Deep Vein Thrombosis
Seizure Disorders/Epilepsy
Pregnancy
Children
Recent Surgery
Vacuum Assisted Therapy (VAT)
Acute Inflammatory Diseases
Pregnancy
Open Wounds/Sores/Skin Inflammation/Skin Irritation/Rashes
ACKNOWLEDGEMENT
By e-signing this waiver, I acknowledge that I have read and understand the above disclosure about Sound Lounge Sessions as offered by Blissed. I, the undersigned, hereby acknowledge and agree to the following terms and conditions before using the Sound Lounge facilities provided by Blissed.
Assumption of Risk: I understand and acknowledge that the use of the Sound Lounge involves certain risks, including but not limited to, the risk of personal injury, property damage, or loss.
I voluntarily assume all such risks associated with my use of the Sound Lounge.
Health Considerations: I affirm that I am 18 years of age or over, weigh less than 300 lbs, height is less than 6’7’, and that I am in good health and free from any medical conditions that might prevent or limit my participation in activities within the Sound Lounge.
* If I am under the age of 18 a parent or legal guardian must review and sign this waiver on my behalf prior to my participation.
Release of Liability: I hereby release and discharge Blissed, its owners, employees, and agents from any and all claims, liabilities, demands, actions, or causes of action arising out of my use of the Sound Lounge facilities.
Equipment Usage: I agree to use all sound equipment and facilities provided by Blissed responsibly and safely. I will not engage in any activity that may cause damage to the equipment or pose a risk to myself or others.
Personal Belongings: I understand that Blissed is not responsible for any loss, theft, or damage to personal belongings while using the Sound Lounge facilities.
Compliance with Rules: I agree to follow and comply with all posted rules and guidelines within the Sound Lounge and follow any additional instructions including safety instructions provided by Blissed and their employees.
I have read and understand the terms of this waiver and voluntarily agree to its content. I acknowledge that my use of the Sound Lounge is contingent upon my acceptance of these terms.
Vibroacoustic Therapy Waiver & Release of Liability
I understand that Vibroacoustic Therapy (VAT) is a relatively new therapy that may help to relieve pain, to process emotions, and to relax and regulate the mind. Every person’s response to VAT is unique. In rare instances, some individuals may temporarily experience negative feelings or memories or uncomfortable physical sensations. There is no guarantee, expressed or implied, that this therapy will cure any condition or disease.
I also understand that if I have:
Hypotension (very low blood pressure )- Contact your Provider before scheduling
An active bleeding disorder or thrombus
Pregnant in the 1st trimester
Had a psychotic episode or have post-traumatic-stress-disorder
There could be a slight risk for an adverse reaction from VAT: I have physician approval and/or have discussed my history of any of the aforementioned disorders with the Vibroacoustic Therapist before receiving treatment. Upon discussion, it may be recommended not to do VAT at this time.
Vibroacoustic Therapy Contraindications: If you have any medical conditions and/or any of the conditions listed:
Pacemakers-Magnets in the transducers of the sound lounge could interfere with a pacemaker.
Pacemaker/Defibrillator/Implantable Devices, Stent/Shunt
Deep Brain Stimulation/Other Implanted Electrical Device
DVT – Deep Vein Thrombosis
Vacuum Assisted Therapy (VAT)
Recent Surgery
Severe or Chronic Mental Illness
Seizure Disorder/Epilepsy
Open Wounds/Sores/Skin Inflammation/Skin Irritation/Rashes
Acute Inflammatory Diseases
Pregnancy
If you have an Infection and or are sick.
ACKNOWLEDGEMENT
By e-signing this waiver, I acknowledge that I have read and understand the above disclosure about Vibroacoustic Therapy (VAT) Sessions as offered by Blissed/Vibroacoustic Therapist. I, the undersigned, hereby acknowledge and agree to the following terms and conditions before using Vibroacoustic Therapy provided by the Vibroacoustic Therapist at Blissed.
Assumption of Risk: I understand and acknowledge that the use of the Sound Lounge involves certain risks, including but not limited to, the risk of personal injury, property damage, or loss. I voluntarily assume all such risks associated with Vibroacoustic Therapy and with my use of the Lounge.
Health Considerations: I affirm that I am 18 years of age or over, weigh less than 300 lbs, height is less than 6’7’, and that I am in good health and free from any medical conditions that might prevent or limit my participation in Vibroacoustic Therapy (VAT) and activities within the Lounge.
Release of Liability: I hereby release and discharge Blissed, its owners, employees, and agents from any and all claims, liabilities, demands, actions, or causes of action arising out of my use of Vibroacoustic Therapy and the Lounge facilities.
Equipment Usage: I agree to use all Vibroacoustic Therapy equipment, Lounge equipment, and facilities provided by Blissed responsibly and safely. I will not engage in any activity that may cause damage to the equipment or pose a risk to myself or others.
Personal Belongings: I understand that Blissed is not responsible for any loss, theft, or damage to personal belongings while using Vibroacoustic Therapy (VAT) and the Lounge facilities.
Compliance with Rules: I agree to follow and comply with all posted rules and guidelines with Vibroacoustic Therapy within the Lounge and follow any additional instructions including safety instructions provided by Blissed, Vibroacoustic Therapist, and their employees.
I have read and understand the terms of this waiver and voluntarily agree to its content. I acknowledge that my use of Vibroacoustic Therapy (VAT) and the Lounge is contingent upon my acceptance of these terms.
Blissed Hydromassage.
Waiver & Consent Form
By e-signing this waiver, I acknowledge that I have reviewed the following information and I understand that the use of the hydromassage is not suitable for individuals with certain conditions.
I agree to seek physician approval before using the hydromassage if I suffer from any of the following conditions or if I have a condition where heat or massage could have an adverse effect:
Heart or circulatory problems
Inflammatory conditions (e.g., phlebitis, varicose veins, or thrombosis)
Swollen joints or acute inflammation
Severe bruising
Skin infections or contagious diseases
A high temperature (fever)
Pain radiating to the arms or legs when the back is massaged
If any of these conditions apply, or if I am uncertain whether the hydro massage is appropriate for me, I will consult my physician prior to the session.
Instructions & Pre-Treatment Guidelines:
Prior to starting the treatment:
Please position yourself in the middle of the lounge, ensuring your legs are together and your feet are resting comfortably at the pump/foot end.
Rest your head comfortably on the cervical support pillow, ensuring the curve of the pillow is positioned under your neck. If your treatment includes the cervical (neck and shoulder) area, you may remove the pillow.
Please dress comfortable and wear layers. Remove shoes and wear socks, and ensure that no belts, jewelry, or items are in your pockets or on your person during the session.
Post-Treatment Guidelines:
After completing your hydromassage treatment, remain lying down for 45 seconds or until you feel comfortable enough to sit or stand.
Be aware that increased circulation may cause dizziness. Please take your time in standing up.
It is highly recommended to drink plenty of water after your session to help your body flush out any toxins that may have been released during your treatment.
Consent & Waiver:
By e-signing below, I acknowledge that I have provided accurate information about my health status, and I have read understood, and agree to the instructions and precautions above. I release Blissed, Blissed The Relaxation Room and their staff from any liability related to the treatment, including any adverse reaction that may arise as a result of the session.
I understand that the hydromassage is a relaxation and wellness treatment, and not a medical procedure. I agree to consult with a physician if I have any concerns about my eligibility for this treatment.
* If I am under the age of 18 a parent or legal guardian must review and sign this waiver on my behalf prior to my participation.
*If I am under the age of 18 (parent/guardian signature required below)
Parent/Legal Guardian Consent (Only required if Under 18)
I am the parent/legal guardian of the minor participant named above. I have read and understand this waiver and release of liability and consent to the minor's use of the automatic massage chairs provided by Blissed. I accept full responsibility for any risks or liabilities associated with their participation.