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Your address.
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Confirm & sign.
Please review your information and read the medical waiver in full before signing.
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, and that access is restricted to individuals receiving medically indicated therapeutic services. Use of the cold plunge pool is only under the oversight and direction of a licensed physical therapist, licensed occupational therapist, or certified athletic trainer.
Medical Condition & Diagnosis Disclosure
By signing this waiver, I confirm that I have a medical condition, injury, or therapeutic indication for which the cold plunge 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 cold shock or dizziness, changes in heart rate or blood pressure, shortness of breath, and muscle cramping or numbness.
Conditions that may increase risk include:
- 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
- Severe chronic obstructive pulmonary disorder (COPD)
- 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 transmissible 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, whether known or unknown, inherent or otherwise, except to the extent caused by gross negligence or willful misconduct.
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You’re covered.
Your coverage is active for today’s visit. Enjoy your session.