The Important Info
Client services and chart information are confidential. Written authorization is required from you to release any information.
• Please drink plenty of water before your appointment
• Please do not consume drugs, medication, or alcohol prior to or during the session
• Please do not eat at least one to two hours prior to your Peri-Steam session to avoid any ill feelings
• Please turn off your cell phone for optimal relaxation
• Your scheduled session is set aside for you. We do not double book appointments
• Please reschedule your session if you are more than 15 minutes late
• 24-hour notice to reschedule is required
• You will be draped in a gown and at no time will genitalia or breast tissue be exposed
• You may not adjust the steam temperature to your comfort level without the facilitator being present
• I understand that my Peri Steam practitioner or I may end the session at any time for any reason
• Inappropriate behavior will not be tolerated and may be prosecuted to the full extent of the law
I understand that V'Jinga and its representatives and employees do not diagnose illness, disease, any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals, or perform any gynecological or obstetric procedures such as paps meres, ultrasounds, sonograms, cervical or pelvic examinations of any kind.
I acknowledge that peri steams are not a substitute for medical examination or diagnosis, and it is recommended that a qualified physician be seen for that service.
It is my choice to receive an herbal peri steam as a form of therapy for my health & wellness.
I understand that the treatment given is designed to address the care and prevention of common genital health issues and imbalances.
I also understand that at any time I feel pain or discomfort during the session, I will immediately inform my practitioner so they may make necessary adjustments, pause or end the session immediately.
I have stated my pertinent medical conditions and will update the practitioner of any changes in my health status.
I understand that my failure to do so may post a threat to my health and/physical well being and I hold harmless V"Jinga and its representatives and employees from any liability whatsoever arising from failure on my part.
Here are recommendations for all clients of thebox:V'Jinga: The use of drugs, medication, or alcohol prior to or during the sauna session may lead to dizziness or unconsciousness. Please consult your physician if you are in doubt of your ability to use the Genital Steam or any of its services for health reasons. Please discontinue the session if you feel light-headed, dizzy, or heat exhausted. Peri steam sessions should be limited to a maximum of 30 minutes. It is advisable to drink plenty of water before and after your Genital Steam sessions. It is advised not to eat at least one to two hours prior to your session to avoid any ill feelings. Clients using any medications must consult a physician or pharmacist prior to the use of the service. We do not provide Organic Herbal Vaginal Steam treatments to women who are pregnant. Excessive body temperatures have the potential for causing fetal damage especially during the early days of pregnancy. By checking the agreement box below, I acknowledge and accept the risks inherent in the use of the thebox:V'Jinga Peri Steam Service. I voluntarily assume the risk of injury, accident, or death, which may arise from the use of the Genital Steam. I and many of my heirs, executors, representatives or assigns hereby release from all claims or liabilities for personal injury or property damages of any kind sustained while being accompanied by thebox:V'Jinga , during the use of the Steam and from any advice provided by an employee, independent contractor or any representative. By signing below you agree that this intake form and liability waiver is in effect for all thebox:V'Jinga Steam Sessions I participate in and will not expire unless requested by either party.
Please input your signature below indicating you have read through the company policies.