VIBE Client Intake & Consent Form

Ensuring your safety, understanding, and consent before EMS training

SECTION 1 - PERSONAL DATA

SECTION 1 - FITNESS GOALS

SECTION 3 - VIBE CLIENT HEALTH SCREENING (PAR-Q)

Please answer YES or NO to the following questions:

If you answered YES to any question above, medical clearance from a GP may be required before participating in EMS training.

SECTION 4 - XBODY CONSENT

DECLARATION

1. I declare to undergo XBody EMS training willingly and through my own responsibility. 

2. I declare that I am aware of the basics of the Electrical Muscle Stimulation (EMS) training method, including any  and all circumstances which contraindicate the training, for instance, cases in which medical consultation is  obligatory or advised and the further warnings and notes as is detailed on page 2 of this document. 

3. I declare myself to be able to undergo XBody EMS training with respect to my current mental state, health, and physical status. 

4. I declare that I am not aware of any contraindication (described below) that may exclude me from the training. 

5. I declare that I have received any and all obligatory medical consultations for the circumstances described  below.  

6. I declare that I will abide by the rules related to the preconditions, aftereffect and the training. 

7. I declare to inform my physician and XBody Trainer in case of any change in my mental, physical and health  status. 

8. I declare to inform my doctor, or any other Medical professional involved in my care, in case of any medical  intervention of undergoing the XBody EMS training. 

9. I declare that in case of omitting or noncompliance with the terms of this agreement I undergo the training fully  and completely through my own responsibility. 

10. I declare that I will not hold XBody Hungary Kft. nor the XBody Trainer responsible if any of my unknown mental,  health or physical conditions cause side effects or complications of any kind. 

11. I declare that I will not hold XBody Hungary Kft. nor the XBody Trainer responsible in case of any side-effects,  complications, lesions or any undesired change in my physical or health status. 

12. I understand that risks due to the long-term effects of EMS training are unknown, therefore I will not hold XBody  Hungary Kft. nor the XBody Trainer responsible for any undesired effect. 

13. I declare to follow the instructions given by the XBody Trainer before, during and after the training. 

14. Due to the necessity of close personal contact while putting on and removal of the Training Suit, I declare that in  no way should this be misconstrued to be a sexual advancement or harassment of any kind. 

15. I contribute that my personal and training data will be registered and used. 

CONTRAINDICATIONS

In the following cases of diseases or conditions, it is forbidden to undergo any electrical muscle stimulation (EMS)  training or treatment. 

1. It is forbidden to use XBody EMS device, if the client has implanted or external medical device (e.g. cardiac  pacemaker, implanted defibrillator). 

2. It is forbidden to use XBody EMS device, if the client has severe cardiovascular diseases (e.g. severe heart or aortic  disease). 

3. It is forbidden to use XBody EMS device, if the client has severe neurological disorder. 

4. It is forbidden to use XBody EMS device, if the client has medication-controlled or medication-uncontrolled  seizures or convulsions (e.g. epilepsy). 

5. It is forbidden to use XBody EMS device, if the client has severe neuromuscular disorder (e.g. rhabdomyolysis or  any disorder that affects the nervous system and the muscles and causes rapid breakdown in muscle structure). 

6. It is forbidden to use XBody EMS device, if the client has cancerous lesions (e.g. breast cancer).

7. It is forbidden to use XBody EMS device, if the client has severe nephrological disease.

8. It is forbidden to use XBody EMS device in case of existence or a tendency of internal bleeding. 

9. It is forbidden to use XBody EMS device in case of non-intact skin (e.g. infected, wounded or any non-healthy,  inflamed, irritated or oedematous skin area). 

10. It is forbidden to use XBody EMS device during pregnancy or suspected pregnancy. 

11. It is forbidden to undergo any intensive training for two days after XBody EMS training.

RELATIVE CONTRAINDICATIONS

In the following cases, medical consultation is obligatory. Any other disease or unusual, abnormal physical condition  or symptom also requires medical approval before undergoing XBody electrical muscle stimulation (EMS) training or  treatment. 

1. Medical consultation is obligatory in case of metal implants. Make sure that electrodes are used in a way that it  is impossible for electrical current to flow through the affected area (e.g. set intensities of such channels to 0). 

2. Medical consultation is obligatory in case of non-metallic or other implants (e.g. silicone implants, gynecological  implants). 

3. Medical consultation is obligatory in case of less severe cardiovascular diseases (e.g. hypertonia, high blood pressure). 

4. Medical consultation is obligatory after a recent surgical procedure, medical intervention or acute trauma or  during any medical treatment (e.g. drug treatment). 

5. Medical consultation is obligatory in case of any hernia (e.g. abdominal or inguinal hernia). 

6. Medical consultation is obligatory in case of chronic disease or fever, contagious disease or any acute or chronic  infections (bacterial or viral). 

7. Medical consultation is obligatory in case of diabetes. 

8. Medical consultation is obligatory in case of the client has painful, sensitive skin or skin areas lacking normal  sensation. 

9. Medical consultation is obligatory in case of menstrual cramps. 

10. Medical consultation is obligatory in case of abnormal obesity or extreme physical inactivity. 

11. Medical consultation is obligatory in case of any mental deficit (client can only use XBody EMS device with  guardianship). 

If you do require medical consultation based on the above relative contraindications, please seek approval before signing this form. You can print of the following GP Information Sheet to help explain the effects of EMS technology.

FURTHERMORE

Parental consent is obligatory in case of underage clients. 

Do not apply electrical muscle stimulation over the neck (especially over carotid sinus nerves or carotid artery). 

Do not put electrode pairs on the opposite side of the heart (electrodes placed on the chest and the upper back),  because the introduced electrical current may flow through the heart which increases the risk of cardiac  fibrillation. 

Do not apply electrical muscle stimulation on the head (e.g. directly on the eyes or covering the mouth). 

Do not apply electrical muscle stimulation together with other electrical measuring instruments applied near on  body surface (e.g. pulsemeters). 

The client must not be affected by alcohol or drugs during XBody EMS training. 

IMPORTANT NOTES

Please read carefully the conditions listed below before starting your training with XBody EMS technology:

1. In case of malaise, ailment, dizziness or feeling aching tightness around the chest or heart area you must inform  the trainer to immediately stop the training. 

2. If you feel any hotness or discomfort on your skin during the training, you need to ask the trainer to switch off the  device. 

3. There will be reflex-like muscle contraction movements caused by stimulation impulses. Maintain pre-contracted  muscles if possible and acquire a stable basic position. 

4. Ensure proper water intake before and after training. 

5. If you feel necessary, have a short break during the training and drink a glass of water. Make sure that you had a proper meal 2-4 hours before your training. 

6. EMS training might cause micro tears in the muscles, which usually leads to muscle soreness, and elevated creatine  kinase (CK-MM) level in the blood. This is a natural reaction of the human body to intensive trainings (such as  XBody EMS training). 

7. In case you have your blood analyzed 2-6 days after your last EMS training it is important to inform your doctor to prevent incorrect misinterpretation of your values. 

We, VIBE BODY CONDITIONING LTD collect your personal data (Name, E-mail, phone) due to your consent to identify and distinguish you from other clients. 

If you have any questions, contact XBody Hungary Kft. Service support for more information on telephone (+36-96-200- 183) or per email (helpdesk@xbodyworld.com). For further information visit our website: www.xbodyworld.com. 

SECTION 5 - MEDIA, MARKETING, PHOTOGRAPHY & TESTIMONIAL CONSENT

From time to time, Vibe Body Conditioning Ltd may take photographs or videos during training sessions for promotional and educational purposes.

These may be used on:

• Vibe Body Conditioning Ltd website

• Social media platforms (such as Instagram, Facebook, TikTok)

• Printed marketing materials

• Promotional advertisements

We may also request written feedback or reviews about your experience.

PHOTOGRAPHY & VIDEO CONSENT

SOCIAL MEDIA & WEBSITE USAGE CONSENT

WRITTEN REVIEWS & TESTIMONIALS

MARKETING

You may withdraw your consent for photography, video, marketing or testimonials at any time by notifying Vibe Body Conditioning Ltd in writing.