CryoEMS Client Waiver & Wishes

Please complete both forms before your first visit


Arctic Blast Cryo CryoEMS Client Liability Waiver


Do not participate in CryoEMS if you have any of the following:

  • Untreated Hypertension
  • Cardiovascular Disease
  • Arterial Occlusive Diseases or Arteriosclerosis
  • Pacemaker, Bullet Fragments and/or Shrapnel in Body
  • Deep Vein Thrombosis (DVT) or known circulatory dysfunction
  • Acute febrile respiratory (Flu like respiratory conditions)
  • Cancer
  • Seizures and/or Epilepsy
  • Cold Allergenic Phenomenon (known allergy to cold)
  • Bacterial and viral infections of the skin
  • Wound healing disorders (open sores or discharging wound/skin conditions)
  • Raynaud’s disease
  • Panniculitis
  • Lipoedema
  • Lymphoedema
  • Kidney Disease
  • Liver Disease
  • Pregnancy or Nursing

You may have other conditions that make CryoEMS inappropriate. Consult with your doctor or medical advisor if you have questions as to whether this treatment is right for you.


  1. Follow all instructions given to you by the attendant.
  2. Participation in CryoEMS involves exposure to cold temperatures of +2 – 0 degrees Celsius. By signing this agreement you confirm that you are in good health and do not have any of the contraindications identified above or other physical condition that would preclude you from safely undergoing the CryoEMS treatment.
  3. If you experience any pain or physical discomfort at any time during the session, let your technician know immediately.
  4. No representations or claims are made as to the exact nature of treatment results. Every individual experience will vary. No results from CryoEMS are assured.  Treatments and/or sessions of CryoEMS are non-refundable.

Waiver and Release:

  1. This is a release of liability and a waiver of certain legal rights.
  2. By signing this agreement you:
    1. Acknowledge that use of CryoEMS involves risk of bodily injury. You acknowledge that you are voluntarily participating CryoEMS with knowledge of the dangers involved and accept and assume all risks as stated above.
    2. Expressly waive and release any and all claims against Arctic Blast Cryo., and its officers, directors, employees, agents, affiliates, successors and assigns (which are collectively referred to as “the Company”), arising out of or attributable to your use of CryoEMS, other than as may arise from the gross negligence or intentional misconduct of the Company. You covenant not to assert any such claims against the Company, and forever release and discharge the Company from liability for such claims.
    3. Indemnify and hold harmless the Company from any loss, liability, damage, cost or expense arising out of or connected in any manner with your use of CryoEMS, except as may arise from the gross negligence or willful misconduct of the Company.
    4. Agree that this waiver and release is intended to be as broad and inclusive as permitted under law.  You specifically acknowledge and agree that this agreement is not intended to be a general release subject to limitations and conditions that would otherwise apply under applicable state law and additionally agree to waive all general release limitations provided by applicable law.

General Provisions:

  1. This agreement shall be construed and interpreted as broadly as possible under the applicable law of the jurisdiction in which you use CryoEMS, with the words, terms, provisions, covenants, and remedies contained in this Agreement to be enforceable to the fullest extent permitted by applicable law.
  2. If any portion of this Agreement is held invalid, the remainder shall not be affected and shall continue in full legal force and effect.
  3. The terms of this Agreement shall continue from this date forever and shall apply to each use by you of CryoEMS without the need for you to resign this Agreement.
  4. This document constitutes the entire agreement regarding your use of CryoEMS and supersedes all prior discussions and representations about the use, CryoEMS.


CryoEMS Waiver

CryoEMS Waiver and Authorization

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  • Please enter moblile number. Appointment confirmations and reminders will be sent SMS. Arctic Blast Cryo does not solicit phone or email.
  • Arctic Blast Cryo does not solicit email and will only be used for notifications of existing appointments or for correspondence about appointments, existing Series, Membership information and payment issues.
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    Receive 10% off all purchases during your birthday week.
  • Rescheduling, Cancellation and No Show Policy: Appointments must be rescheduled within 4 hours of appointment time to avoid a fee. Cancellations must be made 24 hours before the time of service to avoid a fee of $100. Clients who No Show will be charged the full amount of the scheduled treatment or one session of their series on file, if applicable. Credit cards or packages on file will be charged immediately.
  • I have read the above waiver and give consent to receive services, including, but not limited to, CryoEMS & Poly Light at Arctic Blast Cryo. I have read the contraindications and do not have a disqualifying medical condition. I understand that it is my responsibility to discuss my medical condition(s), if any, with a medical professional before having services at Arctic Blast Cryo.

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CryoEMS Client Wishes

Please fill out questionaire so that we can optimally advise you. All data entered is kept completely confidential.

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