Liability Release & Financial Responsibility

(A) I, the undersigned, consent to release Awaken For Wellness LLC, Awaken Hudson Town LLC and any company doing business as Awaken For Wellness (“COMPANY”) from liability for all Services provided by COMPANY and within any COMPANY Building. All Services include, but are not limited to: Infrared Sauna Therapy, Float Therapy, Massage Therapy. I understand that these Services and therapies are for the purpose of relaxation and not intended to treat any condition or disease or to take place of medical care or medications. I Understand that with CBD massage there is a chance that I may fail a drug test and I agree to consult a doctor if I am subject to drug testing. I understand that I can discontinue my Services and sessions anytime. I understand that I take full responsibility to notify COMPANY, if my medical health history should happen to change during the time period of receiving any Services. I have been informed about the fees, I have had the opportunity to ask any questions about its content, and by signing below I agree to release COMPANY and its members from any liability in connection with the therapies I choose to use.

(B) I (Client) understand that COMPANY utilizes online scheduling software that all Practitioners, Sub lessees, independent contractors and Employees (Affiliates) of COMPANY have full access to. All Affiliates will have the ability to see your information you provide on the Contact Form as well as appointment times and with whom you are consulting or doing business. Information you have shared with your Practitioner can be recorded on a SOAP CHART or in other notes within your file which is shared amongst all affiliates.

(C) I understand that the massage therapy given here is for the purpose of stress reduction, relief from muscular tension or spasm, or for increasing energy flow. I understand that the massage therapist does not diagnose illness, disease, or any other physical or mental disorder. As such, the therapist does not prescribe medical treatment or pharmaceuticals, nor do they perform any spinal manipulations. I understand that massage therapy is not a substitute for medical treatments and/or diagnosis and that it is recommended that I see a physician for any physical ailments that I may have. I have stated all my known medical conditions and take it upon myself to keep the massage therapist updated on my physical health. I have received and agree to the “client bill of rights” form as well as all content within this intake form.

(D) I WAIVE, RELEASE, AND DISCHARGE from any and all liability THE FOLLOWING ENTITIES OR PERSONS: COMPANY and/or their officers and employees.

(E) I INDEMNIFY and HOLD HARMLESS COMPANY or its officers or employees for events that may occur on the property of 1821 St. Clair Ave. St Paul, MN 55105 AND ANY OTHER PROPERTY UTILIZING COMPANY’S NAME AWAKEN FOR WELLNESS.

(F) I understand all information provided to COMPANY can be shared with all officers, employees, and affiliated practitioners (practitioners working inside Awaken for Wellness branded businesses). Your information will not be sold or shared with other outside party. Your email will be added to our list for email communication for Newsletters, events and promotions unless you request otherwise. Your email will automatically receive emails from our Scheduling software.

I have read and understand parts A, B, C, D, E, and F above and agree to the above statements.
I understand this form will be shared with COMPANY and its officers or employees.

FLOATING CLIENTS:

Please read if you are floating:

IF YOU ANSWER YES TO ANY OF THE BELOW QUESTIONS, YOU MUST GET A RELEASE FROM YOUR PHYSICIAN BEFORE USING Float Tank.

Please indicate if any of the following apply to you:
1. Do you suffer from Congestive Heart Failure?
2. Do you have a severe current neck injury.
3. Do you have epilepsy?

IF YOU ANSWER YES TO ANY OF QUESTIONS BELOW, PLEASE DO NOT USE FLOAT TANK UNTIL YOU REMEDY THE ISSUE.

Please indicate if any of the following apply to you:

1. Do you have recent flesh wounds?

2. Are you under the age of 18 (Minors must have parent consent form signed)

3. Do you have issues getting up from laying down on the floor?

(You must have someone with to assist you)

4. Are you currently having a heavy menstrual period or any involuntary bodily fluids?

5. Do you have an airborne communicable disease, virus or illness?

6. Are you under the influence of Alcohol or any Hallucinogenic Drugs?

7. Do you have lotions or creams on your body? (please wash off in shower provided)

8. Have you dyed your hair in the last 2 weeks or gotten a spray tan?

INFRARED SAUNA

IF YOU ANSWER YES TO ANY OF THE BELOW QUESTIONS, WE ADVISE YOU TO GET A RELEASE FROM YOUR PHYSICIAN BEFORE USING INFRARED SAUNA.

Please indicate if any of the following apply to you:

1. Do you suffer from Congestive Heart Failure?

2. Are you presently intoxicated from consumption of alcohol?

3. Do you suffer from Parkinson’s, Lupus, Hemophilia, or Multiple Sclerosis?

4. Are you pregnant?

5. Do you have a fever?

6. Do you have recent wounds from an operation or surgery?

7. Do you have a pacemaker or defibrillator?

8. Do you have an acutely inflamed injury or a serious injury occurrence in the last 48 hours?

IF YOU ANSWER YES TO ANY OF QUESTIONS BELOW, YOU NEED TO BE CAUTIOUS. WE CAN SET YOUR FIRST SESSION AT A LOWER TEMPERATURE.

Please indicate if any of the following apply to you:

1. Are you currently taking diuretics, barbiturates, beta-blockers or anti-histamines?

2. Are you over the age of 65?

3. Are you currently having a heavy menstrual period? (could increase flow)

4. Do you have a metal pin, rod, artificial joint or any other surgical implants?

5. Do you have a hard time breaking a sweat?

6. Do you have high blood pressure? Yes No On blood pressure medication?

(Minnesota) Client Bill of Rights

You are entitled to information regarding the degree, training and experience or other qualification of the services that we will be providing you.

The state of Minnesota has not adopted any educational and training standards for unlicensed complementary alternative health care practitioners. This statement of credentials is for informational purposes only.

Under Minnesota law, an unlicensed complementary and alternative health care practitioner may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis from a licensed physician, chiropractor, or acupuncture practitioner, or service from a physician, nurse, osteopath, physical therapist, dietitian, nutritionist, athletic trainer, or any other type of health care provider, the client may seek such services at any time.

The theoretical approach that forms the basis of the services provided by me include performing massage in a professional manner with the intent to benefit the well being of each client, applying massage and bodywork within the scope of my training, utilizing techniques that I am educated on, and refrain from doing massage on clients with conditions / circumstances under which massage should not be performed. You have the right to complete the current information concerning what my assessment and recommendation, including and expected duration of the service provided.

If you have a complaint about your treatment it may be directed to:

Office of Unlicensed Complementary and Alternative Health Care Practice

Health Occupations Program, Minnesota Department of Health

P.O. Box 64975, St. Paul, Minnesota 55164-0975

You have the right to reasonable notice of change in service, which will be posted one month before it will apply. Clients must pay all fees in full at time of services rendered. Cash, Credit Card, and check, are accepted for payment. I do not accept partial payment, waive payment, and contract with HMO’s to provide services or provide billing to insurance companies. If necessary, you may request a receipt for services rendered for your own use.

You may expect courteous treatments and to be free from verbal, physical, or sexual abuse by me.

Your records and transactions with me are confidential, unless release of these records is authorized in writing by the client, or otherwise mandated by law. You have the right to access your records in accordance with Minnesota Statutes Section 144.335.

Other services may be available within the building community. Whatever information I may have concerning services, I will be happy to share it with you should you request it.

You have the right to refuse services or treatment, unless otherwise provided by law.

You may assert these rights without retaliation.