Cryoskin Service Screening Questionnaire

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.

CRYOSKIN Service Screening Questionnaire

Specifically for the CyroSlimming and CyroToning Service:

Specifically for the Cryoskin CryoFacial:

ASSUMPTION OF RISK, WAIVER, AND RELEASE