Safety Guidelines | Mode Mind and Body
WHOLE BODY SONIC VIBRATION: TERMS AND AGREEMENTS
To ensure the safety and enjoyment of all who use the Whole Body Sonic Vibration, please check with your healthcare provider if you are currently experiencing any of the conditions or symptoms listed below. The severe medical conditions listed below will require authorization, in writing, from a licensed medical doctor prior to the use of the Whole Body Vibration.

Acute thrombosis

Serious cardiovascular disease

Pacemaker

Recent wounds from an operation or surgery

Acute hernia, discopathy, spondylolysis

Severe diabetes

Severe migraines

Tumors

Recently placed IUDs, metal pins, or plates

Electrolyte imbalance

Cancer

If you suffer from any of the ailments or conditions below, you may not use the Whole Body Vibration. Please Initial ​the boxes below to indicate that you do NOT​suffer from these conditions.

Metastatic cancer

Joint replacements or metal implants within the last year

Active infection

Pregnancy

Epilepsy

ADDITIONAL WAIVER AND RELEASE OF LIABILITY
  • I understand that all services provided by MODE Mind and Body are not claiming to diagnose, treat, cure or prevent any disease or disorder and that I will consult with my doctor, physician, medical provider, or midwife to discuss the appropriate services for my needs, especially if I am pregnant or have any ailment, diagnosed or otherwise.
  • It is always important to follow your physician's guidance and MODE Mind and Body and its employees cannot offer any medical advice or advise as to if any individual or individual condition should use its services, outside of those explicitly stated herein as not being safe to use its services.
  • MODE Mind and Body is a holistic health Spa. The Company and its Employees are not medical practitioners and make NO medical claims for any of its products or services, and the statements for its products and services have NOT been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease.
  • I will respect all individuals, both Employees and other Clients, while at MODE Mind and Body and not engage in any behavior that could be considered to be unruly, disruptive, threatening, abusive, or illegal (“prohibited behavior”). I understand that MODE Mind and Body reserves the right to refuse the use of its services and facilities at any point for individuals that engage in such prohibited behavior.
  • I do not have any other pre-existing medical conditions, diagnosed or undiagnosed, or have any other concerns as to the safety of using any of MODE Mind and Body’s services for which I have not already reviewed with my doctor, physician, medical provider, or midwife and received their approval.
  • I do not have any mental health conditions which would cause me to harm myself or others.
  • I understand all statements above completely and take on all risks voluntarily.
  • I understand this is a release of liability which could prevent me from filing suit or making claims for damages and agree to hold harmless MODE Mind and Body, the Company and its Employees, from any such claims.
DOWNLOAD WHOLE BODY SONIC VIBRATION ADDENDUM: TERMS AND AGREEMENTS
FAR INFRARED SAUNA: TERMS AND AGREEMENTS
To ensure the safety and enjoyment of all who use the Far Infrared Sauna, please check with your healthcare provider if you are currently experiencing any of the conditions or symptoms listed below. The severe medical conditions listed below will require authorization, in writing, from a licensed medical doctor prior to the use of the Far Infrared Sauna.

Pregnancy/Breast Feeding

Menstruation

Cardiovascular Conditions

Any condition which reduces the ability to sweat or perspire

Hemophiliacs or anyone predisposed to bleeding

Fever

Insensitivity to heat

Joint injuries within the past week or where symptoms are still prevalent

Any surgical implant

Pacemakers/Defibrillators

ADDITIONAL WAIVER AND RELEASE OF LIABILITY
  • I understand that all services provided by MODE Mind and Body are not claiming to diagnose, treat, cure or prevent any disease or disorder and that I will consult with my doctor, physician, medical provider, or midwife to discuss the appropriate services for my needs, especially if I am pregnant or have any ailment, diagnosed or otherwise.
  • It is always important to follow your physician's guidance and MODE Mind and Body and its employees cannot offer any medical advice or advise as to if any individual or individual condition should use its services, outside of those explicitly stated herein as not being safe to use its services.
  • MODE Mind and Body is a holistic health Spa. The Company and its Employees are not medical practitioners and make NO medical claims for any of its products or services, and the statements for its products and services have NOT been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease.
  • I will respect all individuals, both Employees and other Clients, while at MODE Mind and Body and not engage in any behavior that could be considered to be unruly, disruptive, threatening, abusive, or illegal (“prohibited behavior”). I understand that MODE Mind and Body reserves the right to refuse the use of its services and facilities at any point for individuals that engage in such prohibited behavior.
  • I do not have any other pre-existing medical conditions, diagnosed or undiagnosed, or have any other concerns as to the safety of using any of MODE Mind and Body’s services for which I have not already reviewed with my doctor, physician, medical provider, or midwife and received their approval.
  • I do not have any mental health conditions which would cause me to harm myself or others.
  • I understand all statements above completely and take on all risks voluntarily.
  • I understand this is a release of liability which could prevent me from filing suit or making claims for damages and agree to hold harmless MODE Mind and Body, the Company and its Employees, from any such claims.
FAR INFRARED SAUNA: TERMS AND AGREEMENTS
Float Therapy: Terms and Agreements
  • I hereby confirm that I am using MODE Mind and Body’s facilities, including its Float Therapy services, at my own risk. I further understand that while using these services, particularly Float Therapy, that I could fall due to slippery surfaces or other reasons, resulting in severe injury, paralysis, brain damage or death. I acknowledge that I will use caution at all times, including using the handrails, when entering and exiting the Float Pod and the shower in the room to minimize any risk of injury.
  • For your safety, you need to be able to lay down into a supine position on your back and stand back up with only the use of handrails. For your safety and privacy, MODE Mind and Body employees cannot assist you in entering and exiting the Float Pods; however, you are welcome to bring a friend or family member to assist you. If you have concerns, please let us know and we discuss whatever reasonable accommodations we may be able to make for you.
  • If you are pregnant or nursing, if you have or suspect you have a medical condition, are taking any medications, particularly any antibiotics, supplements, water pills, or other prescription or non-prescription medicines that may negatively interact with Magnesium Sulfate, you acknowledge that you have consulted with your doctor, physician, midwife, or health care provider and received their approval to use any MODE Mind and Body services.
  • I hereby confirm and understand that Float Therapy can cause intense relaxation and it could influence motor skills and the ability to drive heavy machinery. Upon exiting the facility I take all responsibility for my actions.
  • I am not taking prescription medicine
  • OR - alternatively, I have consulted my doctor, physician, or medical provider about Float Therapy usage and understand all possible associated risks in combination with my medication
  • OR - alternatively, I understand all possible associated risks in combination with my medication. I am not taking medicine, antibiotics, or water pills that have negative interactions or contraindications with Magnesium, nor do I have any allergies to Magnesium (due to the Magnesium absorbed during Float Therapy)
  • I am at least 18 years of age or am the parent or legal guardian of the individual that will be using MODE Mind and Body’s services if under 18 years of age.
  • If pregnant or potentially pregnant, particularly for those in the first trimester or final month, I have consulted with my doctor, physician, medical provider, or midwife and received their authorization to use the services at MODE Mind and Body. Post-natal women (within approximately 3 months) should also check with and have received approval from their doctor, physician, or midwife prior to using MODE Mind and Body’s services.
  • I am not wearing a pacemaker and do not have any serious heart disease
  • OR - alternatively, I have consulted my doctor, physician, or medical provider and understand all associated risks of Float Therapy usage in combination with my specific medical conditions.
  • I do not suffer from epilepsy (or seizures that are not medically controlled), psychotic attacks, respiratory, kidney or communicable disease.
  • I do not have any skin rashes, skin conditions, or any open wounds. I do not have any infectious or contagious diseases (including the common cold). In rare cases Float Therapy may cause nausea, vomiting, dizziness, and rashes. These could be a sign of a kidney disorder and an inability to process magnesium. Should these symptoms occur please stop use of Float Therapy services and consult your doctor, physician, or medical provider.
  • I am not under the influence of drugs, alcohol or illegal substances.
  • I have no history of ear infections
  • OR - alternatively, I understand all risks associated with Float Therapy and my condition and doctor, physician, or medical provider.
  • I understand that the Float Pod contains 10 inches of water and, while the risk is minimal, could cause drowning or injury if caution is not exercised. I will exercise caution at all times when using MODE Mind and Body’s facilities and services.
  • Please note that women on their menstrual period should abstain from Float Therapy services. Voluntary or involuntary expulsion of bodily fluids will be subject to clean up fees of at least $1000.
  • MODE Mind and Body requires all Clients to go into their Float Pods with clean and oil-free hair to preserve the cleanliness of the carefully maintained water.
  • In order to protect Clients’ hair from potentially being damaged from our Epsom salts in the Float Pod water, while still being able to get all of the benefits of Floating, as well as to ensure no damage occurs to the Float Pod, Clients with any of the following alterations to their hair must inform a MODE Mind and Body Team Member in advance of their Float:
  • Colored/Chemically Treated: This includes any method that unnaturally alters the color or appearance of the hair (i.e., tinted, bleached, permed, or relaxed hair is included in this category).
  • MODE Mind and Body requires that Clients wait to Float until the hair has been washed at least twice after it has been colored or chemically treated. The Epsom salts are known for their detoxifying properties, but unfortunately that also means they can pull the color out of your hair or make it prematurely fade.
  • Extensions and Weaves: This includes human or synthetic hair that is attached (clipped, glued, woven, or otherwise) into a Client’s hair to appear naturally longer. The salt will be very difficult to rinse out and may damage your hair. Therefore, MODE Mind and Body recommends that you Float the day before you go to the hair-dresser so that they can take out and redo the extensions for you.
  • Dreadlocks: This hair style typically requires a lot of product and oils to maintain it, and all Clients are required to take a shower before and after Floating. The salt will be very difficult to rinse out and may damage Clients with this hair style.
ADDITIONAL WAIVER AND RELEASE OF LIABILITY
  • I understand that all services provided by MODE Mind and Body are not claiming to diagnose, treat, cure or prevent any disease or disorder and that I will consult with my doctor, physician, medical provider, or midwife to discuss the appropriate services for my needs, especially if I am pregnant or have any ailment, diagnosed or otherwise.
  • It is always important to follow your physician's guidance and MODE Mind and Body and its employees cannot offer any medical advice or advise as to if any individual or individual condition should use its services, outside of those explicitly stated herein as not being safe to use its services. MODE Mind and Body is a holistic health Spa. The Company and its Employees are not medical practitioners and make NO medical claims for any of its products or services, and the statements for its products and services have NOT been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease.
  • I will respect all individuals, both Employees and other Clients, while at MODE Mind and Body and not engage in any behavior that could be considered to be unruly, disruptive, threatening, abusive, or illegal (“prohibited behavior”). I understand that MODE Mind and Body reserves the right to refuse the use of its services and facilities at any point for individuals that engage in such prohibited behavior.
  • I do not have any other pre-existing medical conditions, diagnosed or undiagnosed, or have any other concerns as to the safety of using any of MODE Mind and Body’s services for which I have not already reviewed with my doctor, physician, medical provider, or midwife and received their approval.
  • I will follow all applicable and appropriate directions for using Float Therapy services, including taking a shower before and after Floating.
  • I have not received a tattoo or piercing nor had my hair dyed within the last 72 hours or longer depending on the specific instructions provided when received.
  • I do not have any mental health conditions which would cause me to harm myself or others.
  • I understand all statements above completely and take on all risks voluntarily.
  • I understand this is a release of liability which could prevent me from filing suit or making claims for damages and agree to hold harmless MODE Mind and Body, the Company and its Employees, from any such claims.
  • I will pay a cleaning fee of at least $1000 on the day of incident should I voluntarily or involuntarily defecate, urinate or discharge any other bodily fluid in the Float Pod or room and my credit or debit card, if on file, will be charged automatically, or a bill to my account will be made now due, if not on file. This is required to offset the loss of having to shut down the Float Pod and room in order to clean it.
  • Similar voluntary or involuntary bodily fluid expulsion anywhere on MODE Mind and Body premises will be subject to the aforementioned clean up fee.
DOWNLOAD FLOAT THERAPY: TERMS AND AGREEMENTS
Magnesphere: Terms and Agreements
Authorization to Use/Release Health Information
I understand and hereby authorize the following:
  1. That Mode, Mind and Body, Inc. and Pico-Tesla Magnetic Therapies, LLC and Magneceutical Health, LLC or its licensors, subsidiaries or affiliates (hereinafter “Companies”), may use and share the following health information about me for Data Management and Data Analysis purposes:
    • Demographic Information (age, sex, ethnicity)
    • Diagnosis (es)
    • Medical History and/or Physical History
    • Medication usage
    • Magnetic Field exposure field strengths, visits, & results
    Survey / Questionnaire: (ie: like relaxation / pain / sleep / QoL scales )
  2. I understand that my medical records are considered confidential and can only be released by a signed and dated authorization from me. I am entitled to request corrections of my medical records.
  3. I have given my authorization knowing that I DO NOT have to sign this authorization, but that if I don’t sign it then the Companies have the right not to let me participate in Relaxation Sessions.
  4. I have given my authorization knowing that I can cancel this authorization at ANY TIME:
    • I have to cancel it in writing, delivered to Companies.
    • If I cancel it, the people the information was given to will still be able to use it because I had given them my permission, but they won’t be able to get any more information about me.
    • If I cancel my authorization, I may no longer be able to receive Magnetic Field exposures.
    • The medical records provided to other people may be given out by them and might no longer be protected.
    • I may request a copy of this form after I have signed/dated it
Informed Consent and Waiver of Liability
I hereby agree to the following:
  1. That I am voluntarily requesting that I be allowed to participate in low level electromagnetic field (EMF) exposure via the ResonatorTM or MagnesphereTM for “ENHANCING FEELINGS OF RELAXATION”, provided by Pico-Tesla Magnetic Therapies, LLC and Magneceutical Health, LLC or its customers, partners, licensors, subsidiaries or affiliates, and Organic Health Center (hereinafter “Companies”).
  2. I understand that there are no known or anticipated medical risks with exposure to the EMF. I also understand that the Companies do not know all of the consequences from its use. The FDA has not decided that the ResonatorTM or MagnesphereTM devices or exposure to them are “safe.” It is possible that I may suffer discomfort or pain, but it is not likely. Severe Injury could occur, but it is extremely unlikely.
  3. I do not have any of the following Health Conditions, and understand that Relaxation Sessions are NOT recommended for those that have:
    • Implanted electrical stimulators in the Brain
    • Chronic Atrial Fibrillation (Uncontrolled)
    • Epilepsy
    • CHF (Congestive Heart Failure)
    • High Blood Pressure (Uncontrolled)
  4. In consideration of being permitted to participate in the EMF exposure, I agree to assume full responsibility for any risks, injuries, or damages, direct or indirect, known or unknown, which I might incur as a result of receiving this exposure.
  5. In further consideration of being permitted to participate in EMF sessions through the Companies, I knowingly, voluntarily and expressly waive any claim I, my heirs, or legal representatives may have against Companies, Pico-Tesla Magnetic Therapies, LLC, Magneceutical Health, LLC, its customers, licensors, subsidiaries, affiliates, owners, directors, or representatives, and Organic Health Center, for any injury, death or damages that I may sustain as a result of participation, and forever release, waive, discharge, and covenant not sue said entities or individuals.
  6. HIPPA Privacy Practices and Authorization to Use/Release Health Information: I acknowledge that I was provided with a copy of the Privacy Practices and Authorization to Use/Release Health Information acknowledging that Pico-Tesla continues its good faith effort to comply with the requirements of Federal Privacy Law. Per my execution of said document I hereby consent use and disclosure of my health information for the purposes and activities permitted under Federal Privacy Law, which are described in the Privacy Practices.
  7. This product and its magnetic field exposures have not been evaluated by the FDA.
  8. This product and its magnetic field exposures is not intended to "diagnose, treat, cure or prevent any disease,"
  9. While participating in Relaxation Sessions, I understand that I should continue to follow (ie do not change) the drug or treatment regimens prescribed by my physician. Federal Electronic Disclosure and Consent
Pico-Tesla Magnetic Therapies and Magneceutical Health and their customers, affiliates, and subsidiaries (hereinafter “Pico”) permit you to fill out and sign certain forms using this web site. This Federal E-Sign Disclosure and Consent describes Pico's process so that you can decide whether you wish to continue with your relaxation sessions through our web site. Please read this page carefully and print a copy of this page for your records. Electronic Signature and Electronic Delivery of Disclosures and Notices By clicking in the box marked "I agree" at the bottom of this page, you consent to use electronic communications, electronic records, and electronic signatures rather than paper documents for the forms provided on this web site. Those forms include
  • The “Customer Agreement / Acceptable Use Policy / and End User License Agreement” that outline the terms and conditions upon which you may engage in Relaxation Sessions via Pico’s website;
  • The “Notice of Privacy Practices involving the Authorization to Use and Release of Health Information”;
  • The “Informed Consent and Waiver of Liability”;
  • All changes and updates to these disclosures, notices, and documents.
You understand that your electronic signature is legally binding, just as if you had signed a paper document. Your consent to use electronic signatures and documents applies only to materials related to your request for Pico to permit you to participate in Relaxation Sessions. Paper Signature and Paper Delivery of Disclosures and Notices If you prefer to use paper signatures, you may instead print a copy of the Documents described above, fill it out, and return them to us by mail or by facsimile. You understand that Pico will not begin to process your request until it receives the executed Documents. You have the right to receive a paper copy of the disclosures, notices, terms and conditions, and other communications described above. There is no cost to receive paper copies of any electronic records. If you wish to receive a paper copy, please send a request with your name, mailing address, daytime telephone number, and the document you wish to receive to one of the following:
  • Email: custservice@magneceutical.com
  • Office: 727.474.3722 (US)
  • Mail: Magneceutical Health, LLC. Attn: Customer Service Department 611 Druid Rd. East, Suite 714 Clearwater, FL33756USA
Withdrawal of Electronic Acceptance of Disclosures and Notices You may withdraw your consent to use electronic signatures or receive electronic communications at any time. If you wish to do so, please notify us at the addresses above and provide your name, mailing address, daytime telephone number, and a description of the type of transaction from which you are withdrawing your consent. Consent By checking the box marked "I Agree," you consent to the use of electronic signatures and to electronic delivery of the disclosures, notices, and communications described above. By checking the box marked "No, thanks," you agree to print out a copy of the Documents, complete them, sign them, and return them to Pico by mail or by facsimile, and to not participate in Relaxation Sessions until same have been received by Pico. DOWNLOAD NOTICE OF PRIVACY PRACTICES