Tell us about you.
A few details to get you checked in and covered for today’s visit.
Your address.
Where do you currently reside?
Confirm & sign.
Please review your information and read the Therapeutic Cold Plunge Medical Use Acknowledgment & Waiver in full before signing.
4150 Mission Blvd. Ste. 242, San Diego, CA 92109 · (619) 377-4421
Medical Use Acknowledgment
I acknowledge and affirm that my use of the cold plunge pool at Ocean Pacific Gym is solely for therapeutic and medical purposes, including aquatic therapy, physical therapy, rehabilitation, or recovery related to a diagnosed injury, illness, or medical condition. I understand and agree that the cold plunge pool is classified and operated as a therapeutic tub, not as a recreational or public-use amenity; that access is restricted to individuals receiving medically indicated therapeutic services; and that use is permitted only under the oversight and direction of a licensed Physical Therapist, licensed Occupational Therapist, or Certified Athletic Trainer.
Medical Condition Disclosure
By signing this waiver, I confirm that I have a medical condition, injury, or therapeutic indication for which cold plunge therapy has been recommended or deemed appropriate. I have disclosed all relevant medical conditions, contraindications, or health risks to the supervising therapist or trainer, including but not limited to cardiovascular conditions, neurological disorders, circulatory issues, pregnancy, or any condition that may increase risk during cold exposure.
Assumption of Risk
I understand that cold plunge therapy involves exposure to cold temperatures and may pose risks including, but not limited to, cold shock or dizziness, changes in heart rate or blood pressure, shortness of breath, and muscle cramping or numbness. I further understand the following conditions may increase risk:
- Unstable angina or recent myocardial infarction (within 6 months)
- Severe or uncontrolled hypertension
- Severe arrhythmias or uncontrolled tachy/bradycardia
- Symptomatic heart failure
- History of syncope related to cold exposure
- Uncontrolled seizure disorder
- Recent stroke or transient ischemic attack (within 6 months)
- Conditions causing impaired thermoregulation (e.g., advanced neuropathy, autonomic dysfunction)
- Severe chronic obstructive pulmonary disease (COPD) with resting hypoxia
- Uncontrolled asthma with cold-induced bronchospasm
- Uncontrolled diabetes with frequent hypoglycemia or neuropathy impairing sensation
- Hypothyroidism with symptoms of hypothermia intolerance
- Chronic skin infections or untreated fungal infections
- Any active communicable disease that could be transmitted via water
- Pregnancy (unless cleared by an obstetric provider)
- Severe Raynaud’s phenomenon
I knowingly and voluntarily assume all risks associated with participation in therapeutic cold plunge use, whether known or unknown, inherent or otherwise, except to the extent caused by gross negligence or willful misconduct.
Compliance With Therapeutic Protocols
I agree to follow all instructions, time limits, temperature parameters, and safety guidelines provided by the supervising therapist or trainer; to immediately discontinue use and notify staff if I experience discomfort, pain, dizziness, or adverse symptoms; and to use the therapeutic tub only during authorized sessions and not for recreational purposes.
Release of Liability
To the fullest extent permitted by California law, I hereby release, waive, and discharge Ocean Pacific Gym, its owners, officers, employees, medical director, therapists, trainers, and agents from any and all claims, liabilities, or demands arising from my participation in therapeutic cold plunge use, except where prohibited by law.
Acknowledgment & Consent
I acknowledge that I have read and understand this Medical Use Acknowledgment & Waiver, that I have had the opportunity to ask questions, and that I voluntarily consent to participate in therapeutic cold plunge therapy under professional supervision.
Activate accidental coverage.
Included at no cost for today’s visit through our insurance partner. Review the benefits and confirm below.
Important disclosure information
This is a brief description of the coverage provided through the Participant Accident Insurance Plan and is not a contract. If any conflict arises between this summary and the master policy, the terms of the master policy govern in all cases. Coverage is underwritten by Zurich American Insurance Company. Certain coverages are not available in all states; some coverages may be written on a nonadmitted basis through licensed surplus lines brokers.
To submit a claim, contact the claims administrator: Health Special Risk, Inc., 8400 Belleview Drive, Suite 150, Plano, TX 75024. Phone 972-512-5600 · Toll-Free 866-409-5734 · Fax 972-512-5818 · claims@hsri.com. A full description of the plan will be emailed to you upon submission.
You’re covered.
Your accidental coverage is active for today’s visit. Enjoy your session.
A confirmation and your plan documents have been sent to .