Forms

Customer Information Form

To expedite the registration process, please fill out and submit the form below. Printing is also optional.



Do any of the below conditions apply to (or your child):
AllergiesAsthmaBronchitisCold & FluCystic FibrosisCOPDGeneral WellnessDermatitisEar InfectionIncrease EnduranceEczemaEmphysemaHay FeverAthletic PerformanceRhinitisPsoriasisSinusitisSleep Apnea/SnoringSmokers CoughStressDetoxOther
How did you hear about us? (Please include the source)
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DISCLAIMER

Salt Remedy reserves the right to alter or modify the below terms and conditions from time to time. Your acknowledgment below constitutes your agreement to any and all terms changed, modified or altered. It is in your best interest to view our website periodically for the latest terms and conditions.

The information contained both herein and on our website is designed to disseminate general information. It is not intended to give medical or pharmacological advice and as such should not be relied upon as a substitute for professional medical advice.

I understand and acknowledge that by entering the premises and employing and of the services offered by Salt Remedy.

  1. I assume all known, latent or anticipated risks;
  2. My participation at Salt Remedy is purely voluntarily and no warranties or representations were made to me by its management to induce me to participate;
  3. I shall assume full responsibility for myself and any of my guests and/or invitees;
  4. I understand that Salt Remedy does not evaluate or diagnose my health and I have received medical clearance prior to engaging in Salt Remedy activities;
  5. I have been advised of the following possible side effects: Dry or itchy throat, nasal drip, and increased coughing at the beginning. This is a natural part of the cleaning process of the respiratory system, during which the pollution, accumulated through a long time, and now loosened up by the salt, are expelled from even the deepest regions of the lungs. Such side effects should cease with the removal of pollution and pathogens. Skin irritation and dermal sensitivity may occur. In such a case, decrease the frequency of sessions.
  6. Salt Remedy has neither applied for or received approval by the Food and Drug Administration or any other consumer protection group;
  7. The use of the rooms at Salt Remedy has not been evaluated by the Food and Drug Administration or any other agency;
  8. The use of Salt Remedy is not intended to treat, cure or prevent any illness or condition. All medical conditions should be treated by a physician competent in treating that particular condition. Salt Remedy assumes no responsibility for customers choosing to treat themselves;
  9. All products and services provided by Salt Remedy, including written information, labels, brochures and flyers as well as information provided orally or in any other medium of communication, hand not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure or prevent any disease. For all your health concerns, please consult an appropriately licensed healthcare practitioner.

Halotherapy is not recommended in the following cases:
Tuberculosis, Fever, Contagious conditions, Severe heart disorders, Existence of cancer, Advanced pregnancy,. Acute state of respiratory attack. The use of Salt Remedy is not intended to substitute for medical care or treatment. Do not stop your medication without first consulting with your doctor. The halotherapy does NOT substitute for any conventional medication. The information contained herein is not intended to cover all possible uses, directions, precautions, warning, drug interactions, allergic reactions, or adverse effects. If you have any questions about Halotherapy check with your doctor before proceeding.

LIMITATION OF LIABILITY. YOU AGREE THAT NEITHER SALT REMEDY NOR ANY PERSON ASSOCIATED WITH SALT REMEDY SHALL BE LIABLE FOR ANY DAMAGES RESULTING FROM YOUR USE OF SALT REMEDY (HALOTHERAPY). THIS LIMIT OF LIABILITY COVERS CLAIMS BASED ON WARRANTY, CONTRACT, TORT, STRICT LIABILITY, AND ANY OTHER LEGAL THEORY. THIS PROTECTION COVERS SALT REMEDY, ITS MEMBERS, EMPLOYEES, AGENTS, AND SUPPLIERS. THIS PROTECTION COVERS ALL LOSSED INCLUDING, WITHOUT LIMITATION, DIRECT OR INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY, AND PUNITIVE DAMAGES, PERSONAL INJURY/WRONGFUL DEATH, LOST PROFITS, OR DAMAGES RESULTING FROM USE OF SALT REMEDY AND ITS FACILITIES.