Salt Room Intake | Cloud9 Spa

Salt Room 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.

General Medical Information

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

Salt Room

I agree that I am at least 18 years of age.

Signature & Date

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

Month

Day

Year