OASIS SKIN & WELLNESS CENTER INC
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    CRYOSKIN Service Screening Questionnaire 

    Specifically for the CyroSlimming and CyroToning Service:

    ​Specifically for the Cryoskin CryoFacial:

    ASSUMPTION OF RISK, WAIVER, AND RELEASE

    By engaging Oasis Skin & Wellness Center INC (for the purposes hereof referred to together herein
    as the “Company”) to provide cryotherapy, hydro massage and or infrared sauna and related
    services (“Services”) and using the Company’s equipment and facilities in relation thereto, I hereby
    acknowledge on behalf of myself, my heirs, personal representatives and/or assigns, that there are
    certain inherent risks and dangers associated with receiving Services and my use of the Company’s
    equipment and facilities.
    At all times, I shall comply with all stated and customary terms, posted safety signs, rules, and verbal
    instructions given to me by staff. If, in the subjective opinion of the Company’s staff, I would be at
    physical risk in receiving Services, I understand and agree that I may be denied access to Services
    until I furnish the Company with an opinion letter from my medical doctor, at my sole cost and
    expense, specifically addressing the Company’s concerns and stating that the Company’s concerns
    are unfounded.
    I hereby (1) agree to assume full responsibility for any and all injuries or damage which are
    sustained or aggravated by me in relation to my receiving of the Services, (2) release, indemnify, and
    hold harmless the Company, its direct and indirect parent, subsidiary affiliate entities, and each of
    their respective officers, directors, members, employees, representatives and agents, and each of
    their respective successors and assigns and all others, from any and all responsibility, claims,
    actions, suits, procedures, costs, expenses, damages, and liabilities to the fullest extent allowed by
    law arising out of or in any way related to the Services, and (3) represent that: (a) I have no medical
    or physical condition that would prevent me from receiving the Services, (b) I do not have a physical
    or mental condition that would put me in any physical or medical danger, (c) I have not been
    instructed by a physician to not receive Services, (d) no warranty or guarantee, or other assurance,
    has been made to me covering the results of the Services, (e) knowing the risks involved I
    nevertheless chose to voluntarily request the Services. Notwithstanding the foregoing (and by way of
    illustration only and not limitation) if any of the following apply to me or if I’m unsure for any reason, I
    hereby acknowledge the Company’s recommendation that I consult a medical physician before
    receiving Services.
    Your participation in the Services will expose you to extremely cold temperatures. I have read this
    Assumption of Risk, Waiver, and Release, fully understand its terms, and understand that I am giving
    up substantial rights, including my right to sue the Company under certain circumstances. I
    acknowledge that I am signing this waiver freely and voluntarily. The term of this waiver is indefinite.
    I acknowledge that I have been urged to avoid bringing valuables into and onto the Company’s
    facilities and the Company shall not be liable for the loss of, theft of, or damage to my personal
    property, including items left in lockers, bathrooms, or anywhere else in the Company’s facilities. I
    acknowledge that no portion of any fees paid by me is in consideration for the safeguarding of
    valuables.
    By providing my signature below, I confirm that the information recorded above is complete and
    accurate to the best of my knowledge. I understand that Skincare & Body Work therapy is not a
    replacement for prescribed medical treatment and that the practitioner may only perform
    treatments within his or her scope of practice and level of comfort. Anything said or performed
    ​during this session shall not be regarded as medical advice, medical treatment, medical
    diagnosis, or medical prescription. I understand that the practitioner may refuse service at any
    time for any reason and that certain medical issues may contraindicate some services and will
    be referred to a medical professional. I understand that it is my responsibility to inform the
    practitioner of any changes to my medical profile, skincare routine, or wellness rituals. The
    practitioner or Oasis Skin & Wellness Center INC will not be held liable for anything resulting
    from my failure to do so. I have disclosed all serious medical conditions and drug use. I realize I
    am encouraged to communicate all treatments with my primary MD. I agree that I have been
    given sufficient opportunity to ask questions and make specific requests in order to make my
    treatment time as comfortable as possible. I have also read and will abide by all policies and
    client expectations that are listed separately from this document.
Submit
Contact Information
Oasis Skin & Wellness Clinic Inc.
707 Walnut St
Murphysboro, IL 62966

info@oasisskincareclinic.net
Call or Text  (618) 207 - 4404
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  • Home
  • Services
    • Oasis Membership
    • Oasis Skin Analysis and Consultation
    • Age Management Facials
    • Procell MicroChanneling
    • Skin Classic
    • Massage
    • Ultimate Oasis Body Molding Service
    • CyroSkin 3.0 Body Treatments >
      • CyroSkin Results Page
    • BioSlimming Body Wrap
    • Solo Spa Sauna
    • Relaxation Station
    • Hair Removal Wax Services
    • Lash & Brow Enhancements
    • Classes
    • Recommended Providers
  • Products
    • Oasis Facial in a Bag
    • Other Recommended Products
  • Gift Cards
  • About Us
    • Employment
    • Cancellation Policy
    • Forms
    • FAQ
    • Reviews
    • Powerful and Pampered
  • Blog
    • Video Library
  • Payment Plans
  • Book Now