Pricing & Gift Voucher - Hobart Float Spa & Massage

Hobart Float Spa Client Consent Form

PLEASE FILL IN THIS FORM PRIOR TO BOOKING A TREATMENT WITH US

Name

First

Last

Address & Postcode

Date of Birth

Gender

Phone

Occupation

How did you hear about us/ by whom?

Please list any relevant medical conditions

Also, please advise if and warts grow on you skin

Are you pregnant? If YES, how many weeks?

When was the last time you tried Floatation Therapy?

When was the last time you tried an Infrared Sauna?

Additional Comments:

You will not be able to float if you have any of the following condition or are in and of the following situations: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -Dyed your hair or recieved any tattoos or peircings within 1 week ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -Suffering from an unstable mental health condition, such as psychosis or have suicidal tendencies ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -An epileptic where seizures could endanger your safetyin the Float Tank ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -Extremeley low blood pressure, heart condition, or pacemaker ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -Severe skin condition such as eczema, a contagious disease or infectious skin condition, or open/infected wounds _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -Less than one week since you experiecned gastroenteritis or diarrhoea ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -Had chemotherapy within the last 2 months _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ *PLEASE KEEP IN MIND THE FOLLOWING THINGS* ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -You will need to remove and make-up and contact lenses before you get in to the float pod ________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -Please limit your shower time to 5 MINUTES to avoid delaying other client's appointments ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -Please DO NOT enter to sauna after a float or shower as water and salt can damage the facilities ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ -If any damage to the float tank or water (due to hair dye, etc.) occurs, you will be held liable for repair costs

DIGITAL SIGNATURE (type your name) AND DATE

Name