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Cryochamber Consent Form


Please fill out the following form
in order to participate in our activity.

I Agree to undertake a procedure of whole body cryotherapy in a cryosauna. The method, purpose, benefits, and risks of undertaking this procedure were fully explained. The risks of this procedure may be: hypoxia (low levels of oxygen in tissues) that may occur if you do not follow the operator's instructions and may lead to reversible and short-term loss of consciousness superficial burns of skin if skin is very sensitive (especially in the leg area) Contraindications: generally bad condition decompensated chronic heart diseases acute myocardial infarction and the recovery period after myocardial infarction stage II or III degree of essential hypertension (blood pressure > 180/100 mm Hg) stage II heart failure arrhythmias with poor prognosis Raynaud's syndrome, acrocyanosis, system vasculitis cryoglobulinemia, agammaglobulinemia, criofibrinogenemia stroke fever active pulmonary tuberculosis malignancy bleeding diathesis severe anaemia hypotheyroidism hysterical neurosis individual intolerance to cold cold urtacaria pregnancy age under 10 years old (NOTE: It is not contraindicated for cryosauna the presence of any implants - sillicon, intraossecus metal rods and plates). I declare that I do not suffer from any of the conditions above, conditions that are not allowed to be exposed to whole body cryotherapy (cryosauna) procedures I declare that I am aware of these risks and I accept them. I understand the nature of the procedure, I want to follow and I admit that I cannot be given a guarantee or assurance regarding the outcome.

Thanks for submitting!

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