CONFIDENTIAL

MEDICAL OVERVIEW AND CONSENT FOR REGEN + WELLNESS WENATCHEE TREATMENTS AND PRODUCTS.
RESULTS ARE NOT GUARANTEED. NO REFUNDS ARE AVAILABLE. CRYO BODY WORKS LLC DBA REGEN + WELLNESS WENATCHEE AND STAFF ARE NOT LIABLE FOR BODILY HARM OR COMPLICATIONS RESULTING FROM TREATMENTS.

Waiver of Liability and Hold Harmless Agreement

1. In consideration for using the treatments and equipment offered by Cryo Body Works LLC DBA Regen + Wellness Wenatchee (Equipment), I hereby release, waive, discharge, and hold harmless Cryo Body Works LLC DBA Regen + Wellness Wenatchee, its officers, servants, agents, employees, and volunteers (hereinafter referred to as “releasees”) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury that may be sustained by any person while using the equipment or due to the use of the Equipment.

2. I hereby confirm that no warranty, guarantee, or other assurance has been made to me covering the results of the treatments. I fully understand the administration of the process, including possible adverse reactions, side effects, or other possible complications. It is understood that this consent is being given in advance of any administration of the process and is being given by me voluntarily to use the Equipment.

3. I am fully aware of the risks and hazards connected with the use of the Equipment, including the risk of physical injury or disability as the result of such injury, and I am voluntarily participating in said Equipment usage and entering the premises to engage in such usage. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury that may be sustained, or any loss or damage to property as a result of being engaged in such an activity. I further hereby agree to indemnify and hold harmless the releasees from any loss, liability, damage, or costs that may incur due to the use of Equipment by me.

4. It is my express intent that this Release and Hold Harmless Agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assignees, and personal representatives, if I am not alive, and shall be deemed as a release, waiver, and discharge of the above-named releasees. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Washington.

5. I understand that the releasees will not be responsible for any medical costs associated with any injury. Any resulting injuries or complications must be verified and documented by a medical doctor for their cause and treated immediately by a medical doctor.

6. I understand that the Equipment is designed for fitness and appearance-enhancing use only by persons in good general health. I have been advised that if I suffer from a medical condition or illness whatsoever, I am not to use the Equipment without my doctor’s written permission.

My signature below constitutes my acknowledgment that (1) I have read, understand, and fully agree to the foregoing consent, (2) the proposed treatments have been satisfactorily explained to me and I have all of the information I desire, and (3) I hereby give my authorization and consent. This consent shall stand as long as I use the Equipment at the location now and in the future. I have read the instructions for proper use of the facilities and do so at my own risk and hereby release the owners, operators, franchisers, or manufacturers from any damage or harm that I might incur due to use of the facilities. In signing this release, I acknowledge and represent that I have read and understand the foregoing Waiver of Liability and Hold Harmless Agreement, I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate, and complete consideration fully intending to be bound by same. Furthermore, I agree that I will comply with all instructions on the use of the devices and that I am using these services at my own risk. I agree to use all sessions within the terms of the contract dates and understand that refunds are not given on unused portions of purchased packages. All services and products sold at Cryo Body Works LLC DBA Regen + Wellness Wenatchee are subject to these terms. Services include infrared laser therapy, infrared photomedicine red light therapy, infrared sauna, ultrasound therapy, ultrasound cavitation RF lipo laser fat reduction therapy, pulsed electromagnetic field therapy (PEMF), inversion therapy, compression therapy, B12 vitamin injections, CBD products, hyperbaric oxygen therapy, and other services.

Laser Therapy Consent

Class IV Laser Therapy Treatment

I hereby authorize and provide permission to perform a Class IV Laser Therapy treatment.

I understand that the Class IV Laser Therapy is a safe and noninvasive treatment and has been cleared by the FDA to emit energy on the infrared spectrum to provide topical heating for the purpose of elevating tissue temperature for the temporary relief of minor muscle and joint pain, muscle spasm, pain and stiffness associated with minor arthritis, promoting relaxation of muscle tissue, and to temporarily increase local blood circulation.

I understand that there is no promise or guarantee regarding the results of the treatment, and that to achieve maximum clinical results, I may need multiple treatments.

I understand that mild adverse reactions, such as mild skin burns, with normal treatment protocols may occur. Some patients may report increased pain after the initial treatment or within 24 hours. I am aware of the following safety requirements.

Eye Safety: I understand that Class IV Therapy Lasers emit both visible and invisible radiation. Protective eyewear is necessary at all times during the treatment. I will not remove the safety goggles until the administrator of the laser has turned it off and provided notification that it is safe to remove them. I will remove all reflective objects, such as rings, metal wristbands, and jewelry prior to treatment with the laser, to avoid reflective surfaces. I will never look directly into the end of the laser therapy handpiece.

Contraindications: I have informed the physician or assistant that I may have or use one of the following:
anticoagulants, meningitis, steroids, autoimmune disorders, multiple sclerosis, systemic infections, encephalopathy, neuronopathy, tattoos, epilepsy (mild), pacemaker, ununited epiphyseal plate, hypersensitivity to laser, photosensitizing meds, ununited fontanelles, iodine-treated wounds, renal failure (severe), lupus (severe), steroid therapy.

Acknowledgement
I have read and understand the foregoing. This laser therapy consent form applies to subsequent visits and treatments.

Vitamin B12 & B12 Complex Injection Consent Form

Do not take B12 injections if you have experienced the following:

• Allergic reactions to vitamin B12

• Allergic reactions to cobalt

• Allergic reactions to latex gloves that are used to administer the shot

• If you are feeling ill or have a fever

• A B12 injection in the last 7-10 days

• If you have ever fainted or experienced a seizure from an injection in the past

• Liver or kidney impairment

• Are pregnant and have not received consent from your doctor

Discuss with your physician taking B12 injections as well as the correct amount of Folic Acid supplements while taking vitamin B12 injections.

I hereby certify that the foregoing history is true and complete to the best of my knowledge and I have received and read the disclosure sheet, have had an opportunity to ask questions that were answered to my satisfaction, and do wish to receive the Vitamin B12 or the B12 Complex injection fully understanding the risks and benefits. I hereby consent to the administration of the Vitamin B12 injection. Furthermore, I hereby release and forever discharge for myself, my heirs, executors, administrators, and assignees, Cryo Body Works LLC DBA Regen + Wellness Wenatchee and their employees, owners, and representatives from any and all claims, demands, actions, and causes of action which may result from participation in this program and have read the information regarding risks and benefits of B12 and B12 Complex. I understand that a B12 injection frequency must be no sooner than seven to ten (7-10) days from the most recent injection. I understand the possible complications of injection therapy including bruising, soreness, and bleeding at injected sites, dizziness, headaches, and possible fainting from the sight of blood. I understand clearly that there is a slight chance for sensitive and adverse reaction to the B12 solution. I am aware that Cryo Body Works LLC DBA Regen + Wellness Wenatchee staff is trained to use an Epi-Pen in the event of a medical emergency and will call 911 for assistance. I hereby release Cryo Body Works LLC DBA Regen + Wellness Wenatchee from all liabilities regarding the treatment with B12 injections. Your personal information and results shall be held strictly confidential.

Pulsed Electromagnetic Field Therapy (PEMF) Consent Form

I hereby authorize and provide permission to perform a PEMF treatment.

DO NOT USE IF:

• Pregnant

• Receiving chemotherapy

• Have cancer or tumors

• Surgery within 24 hours

• Hemorrhagic tendencies, purpura, hemophilia

• Major metabolic diseases uncontrolled by medication

DO NOT USE 1 ft from pacemakers and implanted electronic devices.
DO NOT USE 1 ft from metallic implants.
DO NOT USE soon after taking any medication.
Keep electronic devices away from PEMF.
Maintain hydration before and after treatment.

Adverse Reactions
There are no known or reported adverse reactions with the use of the PEMF unit or therapy. Detoxification may occur after treatment. Drink water and have balanced nutrition. In case of adverse reaction, stop and consult a physician. If you feel discomfort during the treatment please stop the treatment. Users with low blood pressure may experience temporary dizziness when standing up.

I understand that the PEMF is a safe and noninvasive treatment that will emit energy on the electromagnetic spectrum to provide safe and gentle low-frequency electromagnetic pulses for the temporary relief of minor muscle and joint pain, muscle spasm, pain and stiffness associated with minor arthritis, bone-density problems, promoting relaxation of muscle tissue, and to temporarily increase local blood circulation.

Hyperbaric Oxygen Therapy Consent

Hyperbaric oxygen therapy (HBOT) is a medical treatment which enhances the body's natural healing process by inhalation of 100% oxygen in a total body chamber, where atmospheric pressure is increased and controlled. It is used for a wide variety of treatments usually as a part of an overall medical care plan.

Under normal circumstances, oxygen is transported throughout the body only by red blood cells. With HBOT, oxygen is dissolved into all of the body's fluids, the plasma, the central nervous system fluids, the lymph, and the bone and can be carried to areas where circulation is diminished or blocked. In this way, extra oxygen can reach all of the damaged tissues and the body can support its own healing process. The increased oxygen greatly enhances the ability of white blood cells to kill bacteria, reduces swelling, and allows new blood vessels to grow more rapidly into the affected areas. It is a simple, non-invasive and painless treatment.

I understand that this is considered ‘off-label’ and not supported by the FDA (unless the condition is altitude sickness). For this reason, the nature and purpose of hyperbaric oxygen therapy has been explained to me and I understand the explanation. Also, the consequences, risks, costs of treatments, and alternatives to m-HBOT have been explained to me and I have been informed that m-HBOT may need to be repeated in the future, either by repeated sets of treatments or by frequent maintenance treatments in order to help maintain the benefits.

I understand that the atmosphere pressure is 1.5 ATA or 7 PSI and that higher ATA requires full medical prescription from a doctor.

I have informed the attendant of my current health status, all current medications, and therapies, and I agree that it is my responsibility to keep the attendant aware of changes in my condition, medication, or therapies, for every session.

I have been informed that I may refuse treatments at any time, or even terminate a treatment while in the chamber, and exit the chamber in minutes.

I will follow the instructions of the chamber attendant and I will inform the attendant of any concerns during the treatment, such as pain, nausea, diarrhea, dizziness, visual changes, ringing or other noises in the ears, unusual smells, fear or anxiety reaction, unusual sweating, changes in heart rhythm, hiccups, chest pain, faintness, mood changes, difficulty breathing, or any discomfort.

The benefits of m-HBOT may be much greater if I follow a healthy lifestyle, which includes non-smoking, weight control, exercise, proper nutrition, and stress management.

Potential Risks of m-HBOT: Ear drum/sinus discomfort or pain, reversible myopia, confinement anxiety/claustrophobia, fatigue, collapsed lung/pneumothorax, severe lung diseases/lung damage from pressure, heart failure, blood sugars may drop in diabetics, cataract maturation.

What are the benefits of HBOT?
It has long been known that healing many areas of the body cannot take place without appropriate oxygen levels in the tissue. Most illnesses and injuries occur, and often linger, at the cellular or tissue level. In many cases, such as circulatory problems, non-healing wounds, and strokes, adequate oxygen cannot reach the damaged area and the body's natural healing ability is unable to function properly. Hyperbaric oxygen therapy provides this extra oxygen naturally and with minimal side effects. Hyperbaric oxygen therapy improves the quality of life of the patient in many areas when standard medicine is not working. Many conditions such as stroke, cerebral palsy, head injuries, and chronic fatigue have responded favorably to HBOT.

What conditions does HBOT treat? Hyperbaric oxygen is used to treat all conditions which benefit from increased tissue oxygen availability, as well as infections where it can be used for its antibiotic properties, either as the primary therapy or in conjunction with other drugs.

FDA Approved treatments:
Air or Gas Embolism, Carbon Monoxide Poisoning, Compartment Syndrome/Crush Injury/Other Traumatic Ischemias, Decompression Sickness (Bends), Diabetic and Selected Wounds, Exceptional Blood Loss (Anemia), Gas Gangrene, Intracranial Abscess, Necrotizing Soft Tissue Infection, Osteoradionecrosis and Radiation Tissue Damage, Osteomyelitis (Refractory), Skin Grafts and (Compromised) Flaps, Thermal Burns.

Off-label treatable conditions:
Autism, Cerebral Palsy, Lyme Disease, Migraine, Multiple Sclerosis, Near Drowning, Recovery from Plastic Surgery, Sports Injuries, Stroke, Traumatic Brain Injury.

How should clients prepare for treatment?
Only clean cotton clothing is allowed in the chamber. No sharp objects. Nothing highly flammable or that which can create a spark for fire. No cosmetics, perfumes, hair preparations, deodorants, wigs, or jewelry are allowed in the chamber. The technician needs to know if any medications, including non-prescription drugs, are being taken by the patient, and patients are advised not to take alcohol or carbonated drinks for four hours prior to treatment. In most cases, patients should give up smoking and any other tobacco products during their treatment period, as they interfere with the body's ability to transport oxygen.

How is HBOT administered?
HBOT is administered in a private setting in a state-of-the-art monoplace acrylic chamber. This allows our trained technicians to closely monitor the patient and permits the patient to readily see outside the chamber. Patients are in constant view and communication with the attending technician via an intercom or may watch a movie, listen to music, or just rest.

Is HBOT safe? Hyperbaric oxygen therapy is performed under supervision. Although there are minor risks like all medical treatments, overall hyperbaric oxygen therapy is extremely safe. The risks will be discussed with you before you sign your consent form for therapy.

Are there any side effects?
The most common side effect is barotrauma to the ears and sinuses caused by the change in pressure. To minimize this risk, patients learn techniques to promote adequate clearing of the ears during compression or tubes may be inserted in the ears. Occasionally some patients may experience changes in their vision during their treatment period. These changes are usually minor and temporary. A rare side effect is oxygen toxicity which is caused by administering too much oxygen.

What information is needed prior to HBOT?

• If you have any cold or flu symptoms, fever, sinus or nasal congestion, or chest congestion.

• If there is a possibility that you may be pregnant.

I understand that there is a greater chance of claustrophobia inside the chamber because it is tight. I also understand that there are size restrictions in order to safely fit within the chamber. I understand that I will be monitored periodically throughout the chamber to ensure that I want to continue the treatment.

I understand that the Hyperbaric Oxygen Therapy is a relatively safe and noninvasive treatment that will increase oxygen absorption throughout the body. I understand that in an increased oxygen environment there is a greater risk of a fire igniting if a spark became present inside the chamber which could result in serious permanent injury or death. I agree to avoid bringing any items inside the chamber that could increase this risk. I understand that I can exit the chamber alone if absolutely necessary by turning the red valve inside the chamber to release pressure and equalize the chamber back to normal atmosphere. I also understand that only once the pressure is equalized can I unzip the chamber from inside in order to not damage it. I also understand that in the event of a fire I can turn the valve to release pressure and unzip the chamber from inside to escape.

I understand that Cryo Body Works LLC DBA Regen + Wellness Wenatchee is an open treatment environment but that privacy of treatment areas is maintained by closed curtains when in use.

I hereby authorize and provide permission to perform an HBOT treatment.

Membership Policy

If you enroll in our membership program:

Your credit/debit card will be billed for a minimum two (2) full calendar months (in accordance to the date of sign-up) and will continue on a month-to-month basis at the monthly rate until you cancel in accordance with the agreement. Your Monthly Membership Fee is guaranteed so long as you remain a member in good standing including payment of all monthly dues.

To cancel your monthly membership and stop the billing of the Monthly Membership Fee, Cryo Body Works LLC DBA Regen + Wellness Wenatchee requires written notification seven (7) days before the date of automatic renewal delivered in person or sent to the address provided above.

You will be notified if your credit card fails to authorize for any reason, and a $20 late fee will be applied if the credit/debit card is declined.

Your service will be deactivated if your account becomes more than 30 calendar days late.

Do you have or have you had any of the following illnesses? (Please inform our staff):
Diabetes, Goiter/Thyroid Disease, Anemia, Hives, Allergies, Hepatitis, Venereal Disease, Seizures, Rheumatic Fever, Shortness of Breath, Asthma, Heart Murmur, Glaucoma, Heart Valve Disease, High Blood Pressure, Cancer, Low Blood Pressure, Angina Pectoris, Tuberculosis, Heart Attack, Ulcer, Alcoholism, Bleeding Problem, Mental Illness, Gall Stones, Kidney Stones.

Other serious illnesses (Please Explain): ___________________________

Ultrasound Therapy – Contraindications

• Pregnant Women

• Treatment of pain without a professional diagnosis

• Neoplastic areas or areas where a tumor was removed

• It must not be applied over the eyes

• Ischemic areas

• Bone epiphyses that are still growing

• Areas previously treated with radiography

• Gonads to avoid heating

• Where a malignancy is known to be present

• Over reproductive organs, open wounds or lesions

• Over bone growth centers, the brain, spinal cord, or large subcutaneous peripheral nerves

• For patients with implanted electronic devices (cardiac pacemakers, deep brain stimulation devices)

• Over the heart or areas of thrombophlebitis, deep vein thrombosis, emboli, and severe atherosclerosis

• Avoid it over the stellate ganglion, spinal cord after laminectomy, when great tissue resections have been performed, under subcutaneous major nerves, and the cranium

Ultrasound Cavitation RF Lipo Laser

Results are not guaranteed. No refunds.

Restrictions:
Pregnancy, Menstruation, Cancer, Infections or diseases, High or unbalanced cholesterol, Thyroid or immune diseases, Heart diseases or pacemakers, Autoimmune diseases, HIV or AIDS, Blood pressure or circulation problems, Liver or kidney diseases, Antibiotics. Must be 18+ years of age.

Bruising, pain, or other bodily harm is a risk with treatment.
Potential negative interaction with copper IUD. Please avoid.
Any unusual or anomalous negative effects must be reported immediately.

Products

• Use at your own risk

• Do not use if subject to drug testing

All emails and phone numbers will be used for customer relationship and promotional purposes including regular email, calling, and texting.

CONSENT FOR CRYO BODY WORKS LLC DBA REGEN + WELLNESS WENATCHEE TREATMENTS AND PRODUCTS
RESULTS ARE NOT GUARANTEED. NO REFUNDS ARE AVAILABLE. CRYO BODY WORKS LLC DBA REGEN + WELLNESS WENATCHEE AND STAFF ARE NOT LIABLE FOR BODILY HARM OR COMPLICATIONS RESULTING FROM TREATMENTS OR TIME SPENT AT THE FACILITY.

Additional Agreements

1. Waiver of Liability and Hold Harmless Agreement
   I, the undersigned, acknowledge that I am voluntarily using the treatments provided by Cryo Body Works LLC DBA Regen + Wellness Wenatchee, including but not limited to infrared saunas, infrared laser therapy, red light therapy, hyperbaric oxygen therapy, vitamin injections, ultrasound therapy, body contouring, PEMF, compression therapy, and other services. I hereby release, waive, discharge, and hold harmless Cryo Body Works LLC DBA Regen + Wellness Wenatchee, its officers, servants, agents, employees, and volunteers (hereinafter referred to as “releasees”) from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury that may be sustained by me or others while using these treatments and equipment.

2. Understanding and Consent
   I confirm that no warranty or guarantee regarding the results of the treatments has been made to me. I understand that the process and potential adverse reactions, side effects, or complications have been explained to me. I am voluntarily consenting to use the treatments and assume all risks associated with their use.

3. Risks and Assumption of Responsibility
   I am fully aware of the risks associated with the use of the equipment and treatments, including the risk of physical injury or disability. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury that may occur. I agree to indemnify and hold harmless the releasees from any loss, liability, damage, or costs incurred due to my use of the treatments and equipment.

4. Binding Effect
   This Release and Hold Harmless Agreement shall bind my family members, spouse, heirs, assignees, and personal representatives. It will be construed in accordance with the laws of the State of Washington.

5. Medical Costs and Documentation
   I understand that Cryo Body Works LLC DBA Regen + Wellness Wenatchee will not be responsible for any medical costs related to injuries sustained. Any injuries or complications must be verified and documented by a medical doctor.

6. Health Conditions
   I acknowledge that the treatments are designed for individuals in good general health. If I have any medical conditions or illnesses, I must obtain written permission from my doctor before using the treatments.

7. Acknowledgment of Instructions and Risks
   I acknowledge that I have read, understand, and fully agree to this consent form. I have received satisfactory explanations about the treatments, including the possible risks and benefits. I will comply with all instructions for proper use of the treatments and facilities.

8. Membership Policy
   If I enroll in a membership program, I understand that my credit/debit card will be billed for a minimum of two full calendar months and will continue monthly until I cancel in accordance with the agreement. I will provide written notification 7 days before the renewal date to cancel my membership. I am aware of the late fees and potential deactivation of services for overdue payments.

9. Services and Products
   I acknowledge that all services and products provided by Cryo Body Works LLC DBA Regen + Wellness Wenatchee are subject to the terms of this agreement. This includes, but is not limited to, infrared laser therapy, ultrasound therapy, PEMF therapy, hyperbaric oxygen therapy, consumable products, and vitamin injections.

10. Laser Therapy Consent
    I authorize and consent to Class IV Laser Therapy treatment, understanding the associated risks and safety measures. I have been informed of the potential mild adverse reactions and safety requirements, including eye protection and contraindications.

11. Vitamin B12 Injection Consent
    I confirm that I meet the criteria for receiving Vitamin B12 injections and understand the risks, including allergic reactions and possible side effects. I have consulted with my physician as needed and release Cryo Body Works LLC DBA Regen + Wellness Wenatchee from liability related to the administration of these injections.

12. Pulsed Electromagnetic Field Therapy (PEMF) Consent
    I authorize and consent to PEMF treatment, understanding the contraindications and adverse reactions. I agree to follow the precautions and report any discomfort during the treatment.

13. Hyperbaric Oxygen Therapy Consent
    I consent to Hyperbaric Oxygen Therapy, understanding its potential benefits and risks. I will inform the attendant of my health status and any changes, and I acknowledge the potential risks, including claustrophobia and oxygen toxicity.

14. General Health and Contraindications
    I confirm that I do not have any conditions or contraindications listed in the waiver and agree to inform the staff of any changes in my health status.

15. Privacy and Communication
    I understand that my personal information will be used for customer relationship purposes and promotional activities. I consent to receiving communications from Cryo Body Works LLC DBA Regen + Wellness Wenatchee.

All clients acknowledge to be at least 18 years of age, have read and understood this Waiver of Liability and Consent, and agree to all terms and conditions outlined herein.

All memberships are 2 months minimum and are auto-renew. Memberships require 7 days advanced written notice before auto-renewal date to cancel via email to regenwenatchee@icloud.com (or the email address provided by the facility).

Policies and fees for appointment changes, cancellations, no-shows:
Appointment cancellations need to be made 24 hours in advance. Fees: $30 fee for up to 3 appointments. $50 fee for 4+ appointments. The appointment is a No-Show when 15 minutes late and is charged the fee. Same-day rescheduling must be 2+ hours in advance for later in the day or rescheduled a different day in order to avoid a fee. Late arrivals lose that time on appointments and time cannot be added after. Appointments required for all services except vitamin injections.