Danyelle New Massage Client Intake Form

New Massage Client Intake, Privacy Policy & Waiver Form

This form must be filled out prior to receiving services. All follow-up visits will require a different form.

General Information

First name

Last name

Birthday

Month

Day

Year

Phone Number

Address

Emergency Contact Name & Number

Privacy Policy & Waiver

Please read and agree to the following, and check the box below:

HEALTH REQUIREMENTS I confirm that I am not under the influence of drugs or alcohol and am in good mental health. I will inform Cloud9 Spa of any health changes, including allergies or medications. Failure to do so may result in service termination. Any health concerns should be addressed with a physician.
RESPECT THE PREMESIS & POLICIES I agree not to exceed my appointment time or engage in unauthorized activities. I will respect the premises, dispose of garbage properly, and refrain from any theft. No sexual activity is allowed.
LIMIT DISTURBANCES I will silence my phone during treatments and keep my conversation at a low volume.

RESPECT OUR STAFF I understand that misconduct will lead to immediate service termination and potential legal action.
PARENTAL CONSENT Children 12 and older may wait quietly in the lobby; younger children require an appointment with a parent present. Not all of our services are suitable for children.
PETS Pets are not permitted, but service animals are welcome. Owners are encouraged to make other accommodations due to potential allergies of our other clients.
LOSS, THEFT, & DAMAGES Cloud9 Spa is not liable for client injuries, theft, or damage to personal items not caused by staff.
CANCELLATION A $25 fee applies for same-day cancellations, and no-shows will be charged the full fee. Refunds for unused services are unavailable unless an error occurs.

CONSENT I consent to the use of agreed-upon products during my session and will complete my forms accurately. I understand Cloud9 Spa does not diagnose or treat health conditions. Cloud9 Spa agrees to fully respect client privacy, needs and preferences while receiving care and will treat all clients with fairness regardless of gender, political affiliation, or other lifestyle choices. Cloud9 Spa operates within the legal limits imposed upon by federal and state law, and certifying boards such as the NCBTMB, and maintains a lawful business with all necessary policies, procedures, licenses, and certifications in place.

I agree to all the above.

General Medical Information

List ALL known allergies, current conditions (serious or chronic medical conditions [such as diabetes, high blood pressure, blood clots, etc], pregnancy [& how far along, complications, & high risk or not]), etc, you have. If none, please skip.

List ALL medications, surgeries, etc. If not applicable, please skip.

Please list & describe ALL (physical/mental) symptoms you have today, if you have implants/rods/plates, etc, how/when they started, part of the body & activities affected. If none, please skip.

Information About Today's Visit

Have you ever had a professional massage?

Please list any and all therapy/product preferences. For example, oil preferences, pressure preferences, sensitivities, heated/non-heated table, type of massage, etc preferences. If none, please skip.

Let us know if you would like us to focus on an area or avoid an area. If not applicable, please skip.

If you are receiving a CBD massage, you must check this box and sign below to acknowledge that you understand that the oil being used is pure CBD and contains zero THC.

Signature & Date

I agree that I am at least 18 years of age, and/or am attending with my minor child.

If you are signing this form for your minor child, please indicate your names and relation below. Please also sign in the signature block below. Skip if this does not apply.

Signature

Signature field is empty.

Date

Month

Day

Year

New Massage Client Intake, Privacy Policy & Waiver Form

Location & Hours