Red Light Client Intake

Red Light Therapy Client Intake Form

This form must be filled our prior to using our services at each visit for health, safety, and liability purposes as some medical conditions are not fit for some of our services, or require special care.

First name

Last name

General Information

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 the above.

Has your personal information (address, email, phone, etc) changed since your last visit that we should know about? If yes, give us details. If no, please skip.

Has your state of physical or mental health changed since your last visit? If yes, give us details. If no, please skip.

Information for Today's Visit

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.

Signature & Date

Signature

Signature field is empty.

Date

Month

Day

Year

Red Light Therapy Client Intake Form

Location & Hours