Spa Intake Form

Spa at the Lodge | Spa Specials | Shop at the Spa

OPEN THURSDAY-MONDAY BY APPOINTMENT.

Please contact the Spa for scheduling availability and hours. All appointment times based on the availability of staff members.

Reservations required

Questions? Email Us

The spa is closed Thanksgiving Day, Christmas Day and the Fourth of July.

Call for details!
(800) 572-0493

SPA INTAKE FORM

Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone
Age*
Are you under the care of a health practitioner?*
- No
- Yes
Please explain
Any recent surgeries, including plastic surgery?*
- No
- Yes
Please explain
Are you pregnant or trying to become pregnant?*
- No
- Yes
How far along?
Do you have any illnesses, viruses, or infections at this time?*
- No
- Yes
Please explain
Have you had any of these health problems in the past or present?*
- High or low blood pressure
- Skin conditions
- Spinal injury
- Cardiovascular conditions or problems
- Headaches
- TMJ
- Numbness
- Allergic reactions
- Varicose veins
- Cancer
- Claustrophobia
- None of the above
(select all that apply)
Do you*
- wear contacts?
- have any metal implants?
- wear a pacemaker?
- None of the above
(select all that apply)
Are you allergic to nuts, seafood or sensitive to iodine?*
- No
- Yes
Please explain
List any medications we should know about (i.e. blood thinners, blood pressure medication, etc.)
COVID-19
Have you had any symptoms of respiratory illness?*
- Yes
- No
Have you had a fever in the last 24 hours?*
- Yes
- No
Have you been in close contact with a confirmed case of COVID-19?*
- Yes
- No
Please list your daily activities and habits:*
Complaints / Symptoms:
I hereby voluntarily agree to accept services noted below by the staff of Sun Mountain Lodge SPA & Salon for the services to be performed. In agreeing to have such services performed, I am fully aware that there are potential risks involved in receiving these services, and in the use of spa products and chemicals, including but not limited to possible allergic, chemical, or other adverse reactions which might cause injury, illness or death. Being fully aware of such possible adverse consequences, I hereby assume all risk of such injury illness, or death, and hereby release any staff of Sun Mountain Lodge SPA & Salon from and against any and all liability for any harm, injury, illness, damage, claims, demands, action, cause of action, costs and expenses of any nature that I might have or that hereafter accrue to me, arising out of or related to any such injury, illness, illness or death that may be sustained by me as a result of services provided by any staff of Sun Mountain Lodge SPA & Salon.*
- I agree
- I do not agree
I agree to communicate with my service provider about concerns during my treatments. The Spa Technician as a licensed professional has the same right. I understand that the spa personnel do not diagnose illness, disease or any physical or mental disorder, nor do they prescribe medical treatment, or pharmaceuticals. I acknowledge that spa services are not a substitute for medical examination or diagnosis. I have stated all medical conditions that I am aware of and that the answers are true and accurate to the best of my knowledge.*
- I agree
- I do not agree
I also understand that there is no method to completely remove risk of person to person spread of COVID-19 in a massage setting.*
- I agree
- I do not agree
I declare that I am over the age of eighteen and am competent to sign this CONSENT AND RELEASE OF LIABILITY FORM, and that I execute this document freely, knowingly and voluntarily.*
- I agree
- I do not agree

Please note our cancellation policy: Once spa appointments are confirmed please give the Spa or Lodge switchboard 8 hours advance notice to cancel scheduled appointments. No shows and late cancellations will be charged in full.

Call with any questions

(509) 996-2211 ext 227

1 (800) 572-0493

Spa at the Lodge | Spa Specials | Shop at the Spa

OPEN THURSDAY-MONDAY BY APPOINTMENT.

COVID-19

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