At GAMA Wellness in Light& Sound we are concert about your

SAFETY FIRST

The roXiva lamp is not a toy. The visual effects can surprise even experienced people. And so, with a few safety questions taken care of, you will be ready to enjoy your journey. The most important thing for you to remember is that you are always in control of the experience. At any time, you can cover your eyes with a hand or turn away if you experience any discomfort. Don’t push yourself! You can always restart a session with a different intensity. We recommend being well hydrated before a session.

Risk Assesment:

ROXIVA IS NOT SUITABLE FOR EVERYONE

Please read the questions below carefully and circle your answer YES or NO. If you answer YES to any question, then for your safety the roXiva lamp is not suitable for you without further information or written consent from your doctor. Please ask for clarity on any of the questions if you are unsure. Your practitioner has supplementary notes on these questions.


Informed Consent:

PLEASE READ ALL STATEMENTS CAREFULLY

- I confirm that I have read the form carefully, understand the questions and have answered truthfully…
- I confirm that the nature of the roXiva lamp and the session that I am about to experience has been explained to me…
- I confirm that I understand the roXiva lamp is NOT a medical or psychological therapy and is not intended as a treatment or remedy for any condition…
- I confirm that whilst I have never suffered from epilepsy or seizures, I understand that there is a statistical chance of 1 in 3000 that I could be sensitive to flickering light and that this in rare cases could lead to a seizure…
- I confirm that I have been asked whether I have any unanswered questions about the roXiva experience, and that I am satisfied the person supervising my session has the knowledge and experience to supervise…
- I confirm that I am a competent adult of at least 18 years of age, and by submitting this form, I give my informed consent voluntarily.

A copy of your responses will be sent by email to the address you provided.