Day Spa treatment Consent
*please bring a towel and swimmers for all spa bookings*
Or you can hire a towel for $5 from our spa (please ask at reception)
Rest assured that your information is confidential.
Do you wear: A Hearing Aid? Contacts? Dentures? Pacemaker? In which part of your body do you experience stress? Leg Neck Shoulders Back Head Is your stress level: Light? Moderate? Heavy? List injuries not requiring surgery that occurred within the past 2 years (i.e., broken bones, torn ligaments, auto accident)
PLEASE LIST IN THE COMMENTS SECTION ON THE CONSENT AGREEMENT.
DO YOU HAVE ANY CONDITIONS SUCH AS SKIN, BONE, JOINT, OR BACK ISSUES? PLEASE LIST IN THE COMMENTS SECTION ON THE CONSENT AGREEMENT.
Late Arrivals If you arrive late, your session may be shortened in order to accommodate others whose appointments follow yours. Depending upon how late you arrive, your therapist will then determine if there is enough time remaining to start a treatment. Regardless of the length of the treatment actually given, you will be responsible for “full cost” of the cost of session. Out of respect and consideration for your therapist and other customers, please plan accordingly and be on time.
Consent If I experience any pain or discomfort during the session, I will immediately inform the therapist so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that Massage Therapy should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment of which I am aware.
Medical conditions: Because Massage should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical profile and understand that there shall be no liability on the therapist’s part should I fail to do so. This is a Therapeutic Massage session and any sexual remarks or advances will terminate the session and I will be liable for payment of the scheduled treatment. I understand the Massage Therapist practitioner reserves the right to refuse services to me for any reason that she deems necessary.
Male and female genitalia and women’s breasts will not be exposed or touched at any time. Draping will be used for your privacy and comfort. Our policy requires therapists to use draping with sheets/ blankets at all times during every massage session.
Please complete the details on the consent form click below.
IF YOU ARE HAVING INFRARED SAUNA OR MINERAL BATH PLEASE READ BELOW, AND CLICK CONSENT AT THE BOTTOM OF THE PAGE.
Please note the following listed conditions are considered contraindications for the use of Infrared Saunas. Severe medical conditions will require a note of authorisation from your doctor prior to the use of the Infrared Sauna. •
Medications – Diuretics, barbiturates, blood thinners and beta-blockers may impair the body’s natural heat loss mechanisms. Anticholinergics such as amitriptyline may inhibit sweating and can predispose individuals to heat rash or to a lesser extent heat stroke.
Some over-the-counter drugs, such as antihistamines, may also cause the body to be more prone to heat stroke. • Pregnancy – If you are in the early stages of pregnancy (first trimester), you are not permitted to use our sauna. • Cardiovascular Conditions – Individuals with cardiovascular conditions or problems (hypertension / hypotension), congestive heart failure, impaired coronary circulation or those who are taking medications which might affect blood pressure should exercise caution when exposed to prolonged heat.
Heat stress increases cardiac output and blood flow in an effort to transfer internal body heat to the outside environment via the skin (perspiration) and respiratory system. This takes place primarily due to major changes in the heart rate, which has the potential to increase by thirty (30) beats per minute for each degree increase in core body temperature.
• Alcohol – Contrary to popular belief, it is not advisable to attempt to “sweat out” a hangover. Alcohol intoxication decreases a person’s judgment; therefore, he/she may not realize when the body has a negative reaction to high heat. Alcohol also increases the heart rate, which may be further increased by heat stress. Clients who appear intoxicated or inform us of alcohol consumption prior to use of the sauna will forfeit their scheduled appointment and no refund or credit will be issued.
• Chronic Conditions/Diseases associated with reduced ability to sweat or perspire – Multiple Sclerosis, Central Nervous System tumours and Diabetes with neuropathy are conditions that are associated with impaired sweating.
• Hemophiliacs – The use of infrared saunas should be avoided by anyone who is predisposed to bleeding. • Fever – An individual who has a fever should not use an infrared sauna until the fever subsides.
• Joint Injury – If you have a recent (acute) joint injury, it should not be heated for the first 48 hours after an injury or until the swollen symptoms subside. If you have a joint or joints that are chronically hot and swollen, these joints may respond poorly to vigorous heating of any kind.
• Implants – Metal pins, rods, artificial joints or any other surgical implants generally reflect infrared waves and thus are not heated by this system. Nevertheless, you should consult your physician prior to using an infrared sauna.
• Pacemakers/Defibrillators – The magnets used to assemble infrared saunas can interrupt the pacing and inhibit the output of pacemakers.
If you answered YES to any of the above, have you consulted with a medical practitioner about using an infrared sauna? If you do have a medical condition, please consult with your doctor if in any doubt about your safety. While our staff have been trained to know where risks might lie for certain populations, or for certain disorders, it is always recommended to double-check your particular situation with your GP.
client information Please read the following information carefully before signing.
Informed Consent I have no conflicts for use as described in the advisements and contraindications, or I have provided a doctor’s release authorising use. I consent to the Infrared Sauna session and confirm that I am at least 18 years of age.
I understand that I take full responsibility for my own health and well-being. I understand that the services I am receiving are not intended to treat any medical condition or take the place of medical care or medications.
Discontinue the use of the sauna if you experience any pain and/or discomfort, or feel light-headed, dizzy or heat exhausted.
Clients are required to sit on a clean towel or wrap in sarong during their sauna session provided for you.
Clients are required to wear bathers or underwear during the session.
Please complete the Consultation form and tick the consent for this treatment today.
Mineral Bath /Float
While Epsom salt is generally safe, there are a few negative effects that can occur if you use it incorrectly. This is only a concern when you take it by mouth.
First of all, the magnesium sulphate in it can have a laxative effect. Consuming it may result in diarrhoea, bloating, or upset stomach.
If you use it as a laxative, make sure to drink plenty of water, which may reduce digestive discomfort. Furthermore, never take more than the recommended dosage without first consulting your doctor.
Some cases of magnesium overdose have been reported, in which people took too much Epsom salt. Symptoms include nausea, headache, light-headedness, and flushed skin ).
Contact your doctor if you experience signs of an allergic reaction or other serious side effects.
You MUST Shower immediately prior to your session. - We have a shower in the spa
Swimming Bathers MUST be worn for the entire session or we can provide a disposable g string
(BRING A PLASTIC BAG FOR WET CLOTHES)
you must bring your own towel please
The Bath has a operating temperature of 38degrees, the temperature will drop with the lid open, however if you wish to bath with the lid half open please ask staff on your arrival.
Please take Care not to overflow or splash excess water outside the bath when entering in or out.
Please complete the CONSENT form click below.
General Spa Facial - Spa facials, Body Wrap, Exfoliation
I consent to and authorize HARMONY WELLNESS SPA to perform the following procedures I have booked for today.
I have voluntarily elected to undergo this treatment/procedure after the nature and purpose of this treatment has been/ will be explained to me prior to the treatment along with the risks and hazards involved, by HARMONY WELLNESS SPA.
Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications. I also recognize there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost. I will read and understand the post-treatment home care instructions that will be given to me at my treatment and available on request should I require additional information. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult therapist immediately.
I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically. I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I do not hold the therapist at HARMONY WELLNESS SPA responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.
I agree and consent to these treatments and by completing the consultation form agree this is my digital signature and agreement.