Spa Day Client Intake

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Spa Day 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

Massage Therapy

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

List & describe ALL (physical/mental) symptoms you have today and/or any concerns, how/when they started, part of the body & activities affected. If none, please skip.

Lost any recent medications, surgeries, etc. If not applicable, please skip.

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.

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.

I agree that I have not dyed my hair within 48 hours, got any recent tattoos, or have 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, Salt Therapy, & Sound Therapy

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

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*

Signature field is empty.

Date*

Month

Day

Year

Location & Hours

S CLOSED

M CLOSED

T CLOSED

W 9a-7p

T 9a-7p

F 9a-7p

S 9a-7p

Please note: Spa Reservations are available 7 days a week, but with an added fee for "Closed" days..

111 Court Street

Gatesville, NC 27938

252-377-0691

ALL PARKING IS FREE.

WE HAVE A PARKING LOT AVAILABLE NEXT TO THE BUILDING. CLIENTS AND VISITORS MAY ALSO PARK ON THE STREET IN AVAILABLE PARKING SPOTS, OR IN THE PARKING LOT ACROSS THE STREET AT THE CORNER OF COURT ST AND MAIN ST.

Client Check-In

Phone