Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Have you ever used an infrared sauna before? *

Yes

No

Are you pregnant? *

Yes

No

Are you taking medications? *

Yes

No

Are you diagnosed with any medical conditions that may limit or prevent your ability to sweat? *

Yes

No

Do you have unstable angina? *

Yes

No

Have you had a recent heart attack? *

Yes

No

Do you have severe arterial disease? *

Yes

No

Have you been diagnosed with any other medical conditions? *

Yes

No

If you answered YES to any of the questions above; have you consulted with your medical provider about using a Far Infrared Sauna?

Yes

No

It is always important to maintain proper hydration levels during far infrared therapy. Dehydration will actually increase carbohydrate utilization and cause less fat to be burned energy. We highly recommending drinking 4oz to 8oz of water before and after each sauna session. *

I have read the above statement.

Today's Date *

MM

DD

YYYY