Our goal is to help you reclaim and maintain your health and well-being through safe and effective natural wellness services. To provide care tailored to your needs, it is important that you, as the client, read this document carefully and ask any questions before beginning your wellness services.
IN CONSIDERATION for access to the services offered and provided by CASA CALM, LLC d/b/a THE GUILD OF MODERN WELLNESS, a Wisconsin limited liability company (“The Guild”), and use of the facilities of The Guild located at 21415 W. Greenfield Ave., New Berlin, WI 53146 (the “Facilities”), THE UNDERSIGNED, for himself or herself as an individual and on behalf of his or her personal representatives, heirs, assigns, and next of kin (“The Client”), hereby acknowledges and agrees to each of the following TERMS of this INFORMED CONSENT:
1. THE CLIENT WARRANTS AND REPRESENTS THAT:
a. The Client understands that the particular activities which The Client may voluntarily undertake at the Facilities involve, but are not limited to, physical exercise and physical wellness services, including stretching and breathing exercises; massage treatments of various kinds including thermal and vibroacoustic massage; acupressure; head spa treatments including scalp massage, manual or mechanical stimulation, water-based treatments, steam, temperature variation, aromatherapy, vibration, and cleansing or exfoliation of the scalp and hair; exposure to oxygen and ozone; molecular hydrogen therapy delivered through inhalation, ingestion of hydrogen-rich water, topical application, or immersion through hydrogen baths; exposure to various forms of light including but not limited to LED, red LED, and infrared light, including during Theralight photobiomodulation treatments; sauna treatments including exposure to temperatures as high as 195 degrees Fahrenheit for extended periods of time; sensory deprivation treatments; bioresonance treatments; pulsed electromagnetic field treatments commonly referred to as PEMF treatments; vibrational plate treatments; microneedling treatments commonly referred to as SkinPen procedures, which may or may not include platelet-rich plasma treatments commonly referred to as PRP; use of exercise and rebounder equipment; and aerobic activity, including both staff-assisted and self-directed use of wellness equipment and amenities made available at the Facilities (collectively, the “Activities”).
b. The Client is in sufficient physical and mental condition and is able to independently engage in each of the Activities in which the Client chooses to participate, including undressing or repositioning for treatments.
c. The Client understands that The Guild is not a health care facility, does not provide medical diagnosis or treatment, and does not provide emergency medical care. Any need for medical or emergency care may not be immediately available in the event of injury or a health event during participation in the Activities.
d. The Client has reviewed the definition of Pre-Condition in Section 1.e. below and has reviewed and/or discussed contraindications and precautions for any desired Activities with a representative of The Guild prior to participation.
e. The Client is not aware of any disability, diagnosis, impairment, treatment, medication, or other ailment (“Pre-Condition”) that would prevent participation in the Activities, nor does the Client have knowledge of any Pre-Condition that could be detrimental to the Client’s health, safety, comfort, or condition while participating in the Activities, including but not limited to the following:
(i) With respect to whole body vibration plate treatments, any Pre-Condition including:
- Pregnancy
- Diabetes with complications such as neuropathy or retinal damage
- Recent surgery
- Pacemaker
- Epilepsy
- Migraines
- Cancer or tumors
- Herniated discs
- Spondylolisthesis or spondylolysis
- Joint replacements
- Metal pins or plates
- Any of the above without pre-approval from a medical doctor
(ii) With respect to Theralight photobiomodulation treatments, any Pre-Condition noted by the manufacturer, including:
- Pregnancy
- Cancer
- Organ transplant
- Immune suppressant medication
- Steroid injection or treatment
- Open wounds or skin lesions
- Photosensitizing medication
- Seizure disorders such as epilepsy, or electrical sensitivity including electromagnetic hypersensitivity
- Any of the above without pre-approval from a medical doctor
(iii) With respect to SkinPen microneedling procedures, which may or may not include PRP, any Pre-Condition noted by the manufacturer, including:
- Pregnancy
- Autoimmune therapy
- HIV or hepatitis
- Open wounds, sores, or skin lesions including herpes simplex
- Isotretinoin use within the last six months
- Cancer, including skin cancer
- Chemotherapy treatments within the past year
- Acute or chronic infections, sepsis
- Skin diseases such as lupus, porphyria, or severe allergies
- Severe metabolic or systemic disorders
- Abnormal platelet function or blood disorders
- Hemodynamic instability, hypofibrinogenemia, or critical thrombocytopenia
- Chronic liver disease
- Anticoagulation therapy
- Oral or systemic corticosteroid use within the prior two weeks
- Sunburn
- Spray tanning products or self-tanning lotions
- Any of the above without pre-approval from a medical doctor
(iv) With respect to pulsed electromagnetic field (PEMF) treatments, any Pre-Condition including:
- Pregnancy
- Pacemaker, defibrillator, cochlear implant, insulin pump, neurostimulator, or any implanted electronic medical device
- Epilepsy or seizure disorders
- Active bleeding disorders
- Recent surgery or unhealed fractures
- Active cancer or tumors unless approved by a medical provider
- Severe cardiovascular conditions
- Metal implants or foreign bodies depending on device specifications
- Any condition contraindicated for electromagnetic exposure
- Any of the above without pre-approval from a medical doctor
(v) With respect to molecular hydrogen therapy, including hydrogen inhalation, hydrogen-rich water consumption, hydrogen baths, or topical hydrogen application, any Pre-Condition including:
- Pregnancy or breastfeeding
- Severe chronic obstructive pulmonary disease or advanced respiratory conditions
- Uncontrolled asthma
- Active infections requiring medical supervision
- Recent major surgery
- Severe hypotension or dizziness disorders
- Concurrent medical gas or oxygen therapy without approval
- Any condition contraindicated for hydrogen therapy
- ● Any of the above without pre-approval from a medical doctor
(vi) With respect to head spa treatments, any Pre-Condition including:
- Pregnancy due to prolonged positioning or temperature exposure
- Recent head, neck, or spine injury
- History of stroke, aneurysm, or traumatic brain injury
- Severe migraines or vertigo
- Seizure disorders
- Active cancer involving the head, neck, or brain
- Open wounds, lesions, infections, psoriasis flare, eczema flare, or severe dermatitis of the scalp
- Recent scalp surgery, hair transplant, or cosmetic procedures involving the scalp or face
- Sensitivity or allergy to essential oils, botanicals, shampoos, or topical products
- Severe cervical spine instability or disc disease
- Any condition aggravated by water exposure, reclining positions, vibration, or scalp stimulation
- Any of the above without pre-approval from a medical doctor
f. Prior to undertaking any Activities, the Client has disclosed to The Guild all known Pre-Conditions and agrees to disclose any newly discovered Pre-Conditions. This disclosure obligation is ongoing for the duration of the Client’s participation in the Activities or use of the Facilities.
g. The Client understands that The Guild makes no guarantees, representations, or warranties of any kind regarding availability of services or facilities, outcomes, or results. The Activities are wellness-based services intended to support general well-being only and are not intended to diagnose, treat, cure, or prevent any disease, nor to replace medical care from a licensed healthcare provider.
2. RELEASE OF LIABILITY
The Client hereby releases, waives, discharges, and releases The Guild and its affiliates, directors, officers, agents, employees, and assigns (“Releasees”) from any and all liability for loss, damage, injury, or death arising out of or related to participation in the Activities, to the fullest extent permitted by Wisconsin law, except for intentional or willful misconduct. Under no circumstances shall The Guild be liable for indirect, incidental, consequential, or special damages. The Guild’s total liability, if any, shall be limited to the amount actually paid by the Client for the services rendered.
3. INDEMNIFICATION
The Client agrees to indemnify and hold harmless the Releasees from any liability, claim, or expense arising out of or related to the Client’s participation in the Activities, to the fullest extent permitted by Wisconsin law.
4. ASSUMPTION OF RISK
The Client accepts and assumes full responsibility for all risks of bodily injury, death, or property damage arising out of or related to participation in the Activities. The Client agrees to act within personal limits, follow all instructions and contraindications, maintain control of personal movements and equipment, and refrain from conduct that may cause injury to self or others. The Client agrees to promptly notify staff of any discomfort or adverse sensations.
Potential after-effects may include, but are not limited to:
- Redness
- Swelling
- Heat sensitivity
- Pain or soreness
- Lightheadedness or dizziness
- Headache
- Fatigue or deep relaxation
- Scalp tenderness or irritation
- Temporary hair shedding
- Increased bowel movements or urination
- Detox-like symptoms such as nausea or flu-like sensations
- Increased appetite following treatments
- Failure to maintain appropriate diet or exercise regimen
5. OPPORTUNITY TO ASK QUESTIONS
Prior to signing this Informed Consent, the Client has had the opportunity to contact a representative of The Guild to ask questions, seek clarification, and discuss the terms set forth herein.
Having read and fully understood this Informed Consent and understanding the rights voluntarily waived, the Client agrees to the terms herein by electronic signature below, without undue pressure or inducement.