New Client Intake Form

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

General Information

First name

Last name

Birthday

Email

Phone

Address

Emergency contact name and phone number

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

I agree that I am not under the influence of drugs and alcohol, and am of good mental health. I also agree that I am not currently sick with infectious rashes or illnesses, nor am I presenting any symptoms. I will let Cloud9 Spa of any health-related issues.
I agree to not purposefully go over my appointment time, to not partake in extra activities while on the premises, to not touch or change any equipment, decorations, or settings at Cloud9 Spa. I also agree to respect the policies, condition of premises, dispose of all garbage in the trash bins, and not destroy anything within the premises.

I agree to all the above.

General Medical Information

READ BEFORE PROCEEDING: Everyone must complete as some of our services cannot be used for clients with certain conditions, or certain precautions must be taken for safety purposes.

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, type NA.

Information for today's visit

READ BEFORE PROCEEDING: Please only complete the following for which service or services you are receiving today. Clients must fill out an intake form for each visit, so each visit will accommodate which service you are receiving that day. Future intake forms will not be as long, as not as much information will be necessary. Failure to fill out all the sections for the services you are using today may result in a delayed session.

Massage Therapy:

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

Have you ever had a professional massage?

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. Also state any recent medications, surgeries, etc. If not applicable, type NA.

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, type NA.

Float Therapy:

I agree that I am at least 18 years of age. Parental consent is not allowed for float therapy sessions.

I agree to utilize 10 minutes prior to my session to rinse off any hair, body and face products OR I agree to do so prior to attending my float therapy session.

I agree that I have not dyed my hair within 48 hours, no recent tattoos, & no open wounds on my body. I will also avoid shaving the day of. I also agree to not attend my appointment with a full stomach and bladder.

I agree to be aware of water on the floor, and will utilize safety measures (ie: towel) to avoid slipping when walking or getting in or out of the tank.

Red Light Therapy

I agree that I am at least 18 years of age. Parental consent is not allowed for red light therapy sessions.

I agree to be free of makeup, body or hair products that may damage the therapy bed. The clearer the skin, the better the therapy so the light can reach the skin better.

I agree to wear the safety glasses provided, or will bring my own.

Infrared Sauna

I agree that I am at least 18 years of age. Parental consent is not allowed for infrared sauna sessions.

Salt Therapy & Sound Therapy

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

Date