Sensory Assessment & Waiver

Evaluate your sensory condition and acknowledge your participation waiver before entering the pod.

Full Legal Name *

Email Address or Mobile Phone *

Neurological & Sensory Screening

1. Do you have any psychological or psychiatric conditions?

2. Have you suffered any head or brain injuries or strokes in the past?

3. Have you or your family had any history of epilepsy or seizures???

4. Do you have photosensitivity - or do flashing lights trigger migraines, dizziness, or discomfort?

Assumption of Risk & Release of Liability

1. VOLUNTARY ASSUMPTION OF RISK: I acknowledge that sessions inside the Regenesis Pod utilize multi-sensory light frequencies, acoustic vibration, and environmental atmospheric regulation. I affirm that my answers to the neurological and photosensitivity assessment are truthful and accurate.

2. RELEASE OF LIABILITY: In consideration of participating, I release and hold harmless Regenesis, its directors, employees, and authorized agents from any claims, injuries, damages, or liabilities arising directly or indirectly from session participation.

3. DIGITAL SIGNATURE ACKNOWLEDGMENT: By executing below electronically, I certify that I am legally competent to execute this release. This electronic signature satisfies all legal requirements of an ink signature.

I have read, understood, and agree to the assumption of risk & liability terms. *

Draw Digital Signature *

Sign with finger or stylus

✕ Sign on line Regenesis Touch Capture

Select Your Session

Select your preferred Regenesis session protocol below.

1. Rapid Recharge STROBE FREQUENCY

High-efficiency neural recalibration & energy boost