Cryotherapy Services

Consent Form

Cryotherapy Benefits and Risks

Cryotherapy has many benefits including pain relief, muscle relaxation and recovery, reduced inflammation, and increased overall sense of wellbeing. Risks may include frostnip and unsuccessful desired results. Frostnip generally does not lead to permanent damage because only the top layers of skin are involved. However, frostnip can lead to long-term sensitivity to heat and cold.

Treatment Recommendations

We recommend a minimum of five sessions for effective results. Best results occur when treatments are 2 - 7 days apart, but sessions can be up to 14 days apart max. Sessions are normally 30 minutes long. Further touch-up treatments may be required for long-term effective management.

Confidentiality

We will not share your identity and the information we collect from you will remain confidential. Only JDBS Wellness will know your identity and that information will always remain secure.

Photography

Clinical photographs play a key role in the education of professionals in our industry at all levels and thus benefit clients. If in the future, you wish to withdraw consent to use your photos, you have the right to do so at any time by letting us know in writing. Your choice to opt out will not affect your treatment in any way.

Please see our Frequently Asked Questions and Privacy pages for more information.

First name

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I understand the images requested here are required for publication in a journal, textbook, as part of a display or information leaflet, or on an open access website, which may be seen by members of the general public as well as healthcare professionals. To this, I give my consent. If you do not fully understand any of the above, please ask. Your choice of consent level will not affect your treatment in any way.

I also understand that the illustrations requested here may be useful for the purposes of teaching, marketing and research and in view of the explanation given to me, I agree that the illustration may be shown to appropriate professional staff and included in a professionally assessed logbook. If you do not fully understand any of the above, please ask. Your choice of consent level will not affect your treatment in any way.

Client consent to photography: I understand that the illustrations requested here, to which I have agreed, will form part of my confidential treatment records only. If you do not fully understand any of the above, please ask. Your choice of consent level will not affect your treatment in any way.

Informed Conset for Treatment Using Our Targeted Cryotherapy Equipment For All Cryo Services: You have the right to be informed about the recommended treatment plan so that you may make an informed decision as to whether or not to undergo the procedure after knowing the risks and hazards involved. This disclosure is not intended to alarm you but is rather an effort to properly inform you so that you may give or withhold your consent.

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

By signing this form, I acknowledge that I have read this form and/or had it explained to me, that I fully understand its contents, that I have been given ample opportunity to ask questions, and that all questions have been answered satisfactorily.

Thanks for submitting!

NOW OFFERING CRYOTHERAPY SERVICES!!!!!

Cryotherapy Services

Consent Form

info@jdbswellness.com | 678.615.6742

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