Soma Float New Client Agreement

Your First Name*

Your Last Name*

Your Email*

Phone*

Address*

City*

State*

Zipcode*

Date of Birth*

Emergency Contact Name*

Emergency Contact Number*

Their relationship to you

How did you hear about us?

Have you ever experienced flotation therapy before?*
YesNo

What are your wellness goals for today's float?*
Stress ReliefMeditationAthletic RecoveryPain ReliefMagnesium Absorption

How often would you ideally like to float?*
WeeklyMonthlyOccasionally

Would you like to learn more about the cost savings benefits of our Soma Float Monthly Membership Plans?*
YesNoNot at this time

Do you have any interest in learning more about our other wellness services including massage therapy and our relaxing soak room?*
YesNoNot at this time

Important Policies and Procedures

Cancellation Policy: As a courtesy to our guests and service providers, we ask that you notify us a minimum of 24 hours in advance if you must reschedule or cancel your appointment. 30% of the value of the treatment will be charged for cancellations received less than 24 hours before a scheduled appointment. No-shows are charged at 50% of the value of the service.

Cell Phone Policy: We ask that cell phones are turned on silent or turned off completely while in Soma Novo.

I have read and understand the the above policies*
I agree

Release of Liability and Waiver

We make all reasonable efforts to ensure a comfortable, clean, and safe environment for you. Please read over the following information, check the box of each item once read and then sign at the bottom of the form to indicate your agreement and adherence with our policies and procedures.

I must be able to enter and exit the float pod independently, meaning that I am able to independently move to a seated position on the floor and stand back up again without assistance of tools or personal assistance.*
I agree

I will NOT use the Float Pods with oils, lotions, creams or jewelry on my body; nor have I colored my hair or received a spray tan in the last 7 days.*
I agree

I will NOT use the Float Pods if I have any communicable or infectious disease or illness, skin disorder, large cuts or open sores or wounds.*
I agree

I will NOT use the Float Pods if I am under the influence of alcohol or drugs.*
I agree

I will NOT use the Float Pods if I am epileptic, unless in the opinion of my physician, my epilepsy is under control so that I'm in sufficient control of my seizures not to endanger myself in the Float Pod.*
I agree

I will NOT use the Float Pods if I am taking powerful sedatives, have kidney problems, or schizophrenia.*
I agree

I will NOT use the Float Pods if I am pregnant before consulting with my physician and they clear me for use. Floating can be a wonderful experience for a healthy pregnant mother but it would be wise to check.*
I agree

I will NOT use the Float Pod if I suffer or have suffered from chronic heart disease, unless, in the opinion of my physician, my chronic heart disease is under medical control so that I am in sufficient safety to use the Float Pod.*
I agree

I agree that if I am currently under medical treatment for any condition that I will consult with my doctor prior to using the Float Pod.*
I agree

Although no one has ever drowned in a Float Pod, I understand that the Float Pod does contain 10 inches of water that can cause drowning.*
I agree

I further understand that the Float Pods use (1) Epsom Salt, (2) Chlorine, and (3) Natural Enzymes and some people may experience skin allergies or reactions to such chemicals.*
I agree

In rare occasions flotation causes nausea, dizziness and rashes. These could be a sign of a kidney disorder and an inability to process magnesium. Should these symptoms occur please stop use of the Float Pod and consult your doctor.*
I agree

I hereby agree that if I voluntarily or involuntarily soil or leave dye or oils in the Float Pod that I will be required to pay the cost of cleaning and refilling the pod with salt. (Approx $800-$1000 depending upon the price of salt)*
I agree

Upon using the Float Pod, I absolve Soma Novo and it's employees and agents from any and all liability in connection with the use thereof whether such loss or damage be direct or indirect. I further agree to take full responsibility for my thoughts and actions while floating. The waiver of liability and all agreements made herein shall apply to each use of the Float Pod.*
I agree

Until clients are 18 years old they are considered a minor and therefore we require parental approval before receiving services. Clients 15 years old or younger must have written permission to receive their first session and a parent must be present in the treatment room for the entirety of the session. For clients between the ages of 16 and 17 we require written permission from the parent and the parent must accompany the minor to fill out approval form. Consent to Treatment of Minor: By my signature below, I hereby authorize Soma Novo to administer massage and bodywork to my child or dependent as they deem necessary.*
As a parent or guardian I give permission for treatment.

Parent/Guardian Name*