Intake screening and contraindications: building a per-modality question set a studio can actually run

Two documents get confused in almost every studio, and the confusion is expensive in a quiet way. A waiver is written for a dispute that has already happened: it allocates risk, records that a person was told something, and lives in a file opened by lawyers. A screening flow is written for the next sixty minutes, and exists to change what the studio does: which questions get asked, which sessions go ahead as booked, and which person is sent to a clinician instead of into a room. A studio can have a perfect waiver and no screening at all, and most that discover this discover it late.

The second confusion follows from the first. Because a waiver is generic by design, studios build a generic intake form beside it and run five modalities off it. That cannot work, because the useful questions are not shared. What you need to know before someone sits in a hot room is not what you need before a hyperbaric session, which is not what you need before an hour of deep pressure work.

Screening is modality-specific or it is decorative.

This guide is not medical or legal advice, and it does not tell you who is safe to serve. That judgement belongs to a clinician, and part of the job of a screening flow is making sure it never quietly relocates to your front desk. Every question below is written to be asked, recorded and, on a positive answer, referred. The studio's competence is in asking well and writing it down.

A waiver allocates liability; a screening flow changes the next hour

Test any intake process against one scenario. It is 6pm, three people are waiting at the desk, and a member mentions in passing that they had ear surgery a few weeks ago and have booked a hyperbaric session. If what happens next depends on whether the staff member on shift happens to know that matters, you have a waiver and a hope. If the booking flow already asked, the answer was recorded, and a flag reached the person running the session, you have a control.

Build them as separate artifacts with separate owners: your attorney owns the waiver, and your operations lead owns the screening flow and answers for whether its answers reach whoever runs the session. The difference shows up three ways. A waiver is signed once and refreshed rarely; a screening answer has a shelf life, because a fever, a new medication or a recent surgery are facts about today. A waiver is comprehensive and unread; a screening question has to be short enough to be answered truthfully at a counter. A waiver protects the business; a screening flow protects the person in front of you.

Why one form cannot carry a multi-modality floor

The generic form fails for a structural reason, not a drafting one. Each modality carries its own risk mechanism, and the questions that surface it are specific to that mechanism. Heat loads the cardiovascular system and dehydrates. Extreme cold in an enclosed chamber has its own documented adverse-event profile and, in liquid-nitrogen designs, its own burn and hypoxia hazard. Hyperbaric adds pressure and an oxygen-rich enclosure. Hands-on work applies force to tissue. None of that is captured by asking "any medical conditions we should know about?"

A generic question also produces unusable data: a free-text box about conditions gets answered with a blank, a joke or a novel, and none of the three is something a staff member can act on at 6pm. The practical build is a short common core plus a per-modality block that appears only when the relevant service is booked, with each question on it existing because a source supports asking it. If you cannot say why a question is on the form, it should not be there, because every extra item lowers the response quality of the ones that matter.

• Common core: identity, emergency contact, whether a clinician is managing anything that makes this kind of session a question for them, medications, and consent to record the answers.
• Per-modality block: shown when the service is booked, three to six closed questions, each traceable to a source.
• A written action for every answer, so nobody improvises a decision they are not qualified to make.

Heat: the question set, and the alcohol line

Heat is the modality where the operator guidance is clearest and most often ignored. Harvard Health states that pulse rises by 30% or more in a sauna, nearly doubling cardiac output, that saunas appear safe for most people, and that people with uncontrolled hypertension or heart disease should consult a physician. Its practical guidance is floor-ready: limit sessions to 15 to 20 minutes, avoid alcohol, cool down gradually, rehydrate[5], and leave immediately if unwell. Four of those five are room policy, not screening questions, which tells you where heat safety is actually enforced.

CDC's heat-health guidance supplies the rest. It lists the symptoms of heat illness as cramping, heavy sweating, shortness of breath, dizziness, headache, weakness and nausea, which is the list your staff should be able to recognise and which belongs on a card near the cabins. It names higher-risk groups including children with asthma, people with heart disease, pregnant women[4], and adults 65 and over. And it advises reviewing medications with a doctor, because some increase dehydration or overheating risk, which is why a medication question belongs on the form even though a studio has no business interpreting the answer.

Then there is alcohol, the single most actionable finding in this guide. A Netherlands Heart Journal letter reports that sauna is well tolerated and poses no risk to healthy people, and that 44% of Swedish and 50% of Finnish sauna-related deaths involved alcohol[6]. Harvard's guidance says to avoid alcohol. Between them that supports a written floor policy rather than a norm: a visibly intoxicated person is not admitted to heat, alcohol is not served before a heat service, and a venue that sells alcohol at all designs the sequence deliberately.

• Has a clinician told you that you have high blood pressure or a heart condition? Recorded and referred, following Harvard Health's guidance that people with uncontrolled hypertension or heart disease should consult a physician.
• Are you pregnant? Recorded and referred, given that CDC names pregnant women among higher-risk groups for heat.
• Are you taking any medication? Recorded, with CDC's advice to review medications with a doctor printed on the form.
• Asked at every visit, not at signup: have you had alcohol today, and do you feel unwell right now.

Cold and whole-body cryotherapy: the equipment type changes the question

For whole-body cryotherapy the best operator-facing evidence available here is an international scoping review published in the European Journal of Medical Research in 2023. Across seven studies it documented 16 adverse events, the serious ones including intracerebral hemorrhage[3], abdominal aortic dissection and transient global amnesia, with minor events including cold panniculitis, urticaria, headache and reactive hypertension, and it concludes that adverse events appear rare relative to how widely the practice has grown. Both halves of that belong in staff training: rare, and documented.

The operationally decisive finding is the distinction it draws between device types. True whole-body cryotherapy in a refrigerated-air chamber is not the same exposure as a partial-body liquid-nitrogen cryosauna, and the review notes the latter carries higher burn and hypoxia risk. So the equipment you own changes the protocol, the training and, for nitrogen, the ventilation and monitoring questions about the room itself. Your record should also say which device a person used, because a log that says only cryotherapy has thrown away the distinction that matters.

Be careful about what you extend from that evidence. It concerns cold-air chambers and cryosaunas, and it is not a contraindication list for cold-water immersion, which is a different exposure with a different evidence base. Where an operator has no source specific to a service, the move is the same one as everywhere else in this guide: ask the general question, record the answer, follow the manufacturer's instructions, and refer. Do not import a list from a neighbouring modality because it looks close enough.

• Which device is this? Record chamber type, because refrigerated-air and liquid-nitrogen exposures are not interchangeable in risk or protocol.
• Is a clinician currently managing a cardiovascular or circulatory condition for you? Recorded and referred rather than assessed.
• Do you have an open wound, a skin condition or an area of reduced sensation? Recorded, given that documented minor events include cold panniculitis and urticaria.
• Asked at every visit: are you unwell today, and have you had alcohol today.
• Staff-side: a trained operator present throughout, a documented stop procedure, and, for nitrogen systems, the room ventilation and monitoring answers written down before the service opens.

Hyperbaric: the shortest question set, the highest stakes

Hyperbaric oxygen carries the shortest list and the least room for improvisation. Cleveland Clinic names groups who should not receive it, including people with a collapsed lung[1], lung disease such as COPD, cystic fibrosis or emphysema, an active fever or cold, or a recent ear injury or surgery. It also stresses receiving it only from an experienced provider in an accredited facility and only for approved conditions, a statement about the setting, not about the person, and the first thing an operator should reconcile with what their business actually is.

FDA's 2025 letter to health care providers adds the operator-side obligations. These are Class II devices cleared through 510(k), the agency is aware of reports of serious injuries and deaths associated with their use, the named risks include fire hazard from high oxygen concentration, static electricity from wool or synthetic fabrics and equipment malfunction absent proper maintenance, and providers must follow each device's manufacturer instructions. The garment rule that follows from the static hazard is a screening item in practice: what someone is wearing is checked before a session, not after.

Note the shape of the fever question, the clearest example of the difference between a waiver and a screening flow. An active fever or cold is a fact about today, and no signature collected at signup can answer it. A process that asks it once, at joining, does not ask it at all.

• Have you ever had a collapsed lung, or been told you have a lung condition such as COPD, cystic fibrosis or emphysema?
• Have you had an ear injury, ear surgery or sinus surgery recently?
• Do you have a fever, a cold or a respiratory infection today? Asked every visit.
• Do you have difficulty in enclosed spaces?
• Checked rather than asked: what the person is wearing into the chamber, against the device's own instructions and the fabric and ignition rules the fire hazard requires.

Hands-on work and quiet rooms

For massage, NCCIH states that the risk of harmful effects appears to be low, with rare serious complications including blood clots[7], nerve injury and bone fracture, particularly with vigorous deep-tissue work or in elderly patients. Read as an operating instruction, that says the screening variable is pressure and the population variable is age and fragility. The questions worth asking are whether a clinician is currently managing anything that makes deep pressure a question for them, whether there is a recent injury or surgery, and what pressure the person wants. The last is a safety question dressed as a service question, and a therapist working to what the tissue tolerates is a different service from one complying with an order for the deepest pressure available.

For breathwork, guided relaxation and the quiet end of a recovery menu, NCCIH states that relaxation techniques are generally considered safe for healthy people, with rare reports that some might cause or worsen symptoms in people with epilepsy or certain psychiatric conditions, or in people with a history of trauma. That is a narrow and specific statement, and it supports a narrow and specific practice: ask whether a clinician is managing epilepsy or a mental health condition, record the answer, refer rather than assess, and give every instructor a script that makes stopping at any point normal and unremarkable, not a disruption.

The modalities where we have no source, and what to do instead

Two services common on recovery menus, PEMF and red light, appear here without a contraindication list, and that is deliberate: no verified contraindication source for either was available when this was written. The temptation to fill the gap from memory or from a competitor's form is strong, because a blank space on an intake document looks like an oversight. It is the more damaging option by a wide margin, since a fabricated list gets printed, handed to a member and read as clinical guidance from someone qualified to give it.

What replaces the list is a procedure. Ask the manufacturer what its instructions for use say about who should not use the device, and copy that into your procedure verbatim rather than paraphrasing, because the paraphrase is where an invented claim gets born. Ask the general question about clinician-managed conditions and medications, record the answers against the person, and refer anything uncertain. Follow the device instructions on parameters and session length, which for FDA-regulated equipment is an obligation rather than a courtesy.

Apply the same discipline whenever you add a service. The first question about a new modality is not what it does. It is which published source describes its risks, and what that source supports asking. If the answer is none, you can still run the service, and your form should say what you actually know instead of performing a confidence you do not have.

Re-asking and re-signing run on two different clocks

Most studios have one intake event, at signup, and nothing after it. The correct design runs two clocks at different speeds. The waiver clock is slow: a re-signature is triggered by a policy change, a modality the member has not previously agreed to, a material change to your terms, and whatever periodic refresh your attorney recommends. That cadence is a legal question, not something a guide can set.

The screening clock is fast, and it is set by the nature of the question rather than by the calendar. State-dependent items are facts about today and have to be asked today: fever or illness, alcohol, feeling unwell, a new medication, a recent injury or surgery, and pregnancy where it is relevant to the service. History items are stable and can be asked at signup and refreshed periodically. The failure that produces most incidents is a state-dependent question asked once, at signup, and then treated as permanently answered.

The per-visit ask has to survive a busy counter, which means two or three questions rather than a form. Put them in the booking flow where possible so the desk confirms instead of interrogating, and give the desk one sentence to say out loud. A studio that asks two good questions every visit is safer than one asking twenty excellent questions once a year.

• Asked every visit: do you feel unwell today, have you had alcohol today, and has anything changed since we last asked.
• Refreshed periodically: the per-modality history questions, on a cadence you set and can evidence.
• Re-signed on a trigger rather than a schedule: policy change, new modality, terms change, plus any refresh your attorney sets.
• Recorded every time, not only when an answer is interesting, because an absent record and a negative answer look identical later.

Who asks, what gets written down, and the referral script

Draw the staff boundary explicitly and train to it. Any trained staff member may ask the questions, read out the risk disclosure, record the answer exactly as given, and follow a written action. No unlicensed staff member interprets an answer, reassures a member that a condition is probably fine, or decides a flagged person can proceed. That boundary keeps a competent hourly employee from being asked, several times a shift, to make a clinical judgement they were never trained or paid to make.

The record has to be findable mid-shift, which is harder than it sounds. An answer living in a signup PDF, a form provider nobody logs into, or a paper file in the office is not available to the person running the session at 6pm. It should attach to the member and show on the booking, with any flag surfacing on the day's schedule. The test: can the person about to run this session see the answer in under thirty seconds without leaving the screen they are on.

Praxium does not hold that record and should not. The free directory carries studio profiles for city and modality searches, and the optional protocol layer plans sequences out of a studio's own menu. The screening answer belongs in the system that owns the booking, and no plan, ours or anyone else's, should route a member into a service their record has flagged.

Finally, script the referral, because an unscripted one becomes either an argument or a reassurance. One or two sentences, said the same way every time, naming the action rather than the reason and offering something concrete: "that is a question for your doctor, not for us, so we will hold the booking, and here is what we can run for you today instead." Record the referral and the alternative, and the member comes back with an answer, not a grievance.