Forms

As the sole owner, I am allowing my horse to receive cryotherapy treatment(s). I fully understand that cryotherapy is not a substitute for medical treatment or medications, and that it is recommended that I work with my Veterinarian for any medical conditions that my horse may have. I also fully understand that any and all cryotherapy treatments are for the purpose(s) of reducing swelling and inflammation; providing relief from minor aches and pains; stimulating circulation; and/or improving range of motion. I fully understand that the licensed CoolStride LLC specialist cannot treat, cure or prevent lameness, illness or disease, and cannot prescribe medications. I also fully understand that any information provided by the CoolStride LLC specialist is for educational purposes only, and is not diagnostically prescriptive in nature. I also fully understand and agree that it is solely my responsibility to contact and apprise my Veterinarian of any changes to my horse’s physical condition, limitations, medical condition and medications. By signing this Waiver and Release of Liability, I hereby waive and release CoolStride LLC, the specialist listed below, and all agents and employees, from any and all liabilities, past, present and future, whether known or unknown, arising out of cryotherapy treatments and/or any other services provided by or on behalf of CoolStride LLC.

I acknowledge that I have been informed about the potential contraindications for the application of cryotherapy, which include but are not limited to:

• Bleeding disorder
• Cancerous metastatic tumors
• Cardiac or respiratory involvement
• Cold hypersensitivity
• Colic or tying up (Exertional Rhabdomyolysis)
• Contagious fungal or bacterial infections
• Cushing’s disease
• Extreme fatigue
• Loss of thermal sensitivity
• Raised temperature (fever)
• Pregnancy
• Poor circulation
• Raynaud syndrome (insufficient blood supply in the distal digits)

I confirm that my horse does not have, and does not exhibit signs or symptoms of, any of the above-listed contraindications. I further confirm that I have had the opportunity to discuss any concerns with a Veterinarian, and that I understand the risks and benefits associated with cryotherapy treatment(s).

By signing this document, I give my consent for (Horse’s Name) to receive cryotherapy treatment(s). I understand that while every precaution will be taken to ensure the safety and well-being of my horse, there are inherent risks involved with any alternative treatment(s).