Client Intake Form

Welcome to Salt Spa Wellness, Weโ€™re So Glad Youโ€™re Here
Thank you for taking a moment to complete this form prior to your appointment. The questions below help us tailor your experience and keep you safe during your visit. To keep things simple, weโ€™ve included all of our services in one form โ€“ no need to fill out a separate intake for each modality. Even if youโ€™re only planning to use one or two services, having everything in one place allows us to better serve you and keep your wellness journey as smooth as possible.
We appreciate your time and look forward to helping you relax and recharge.

Date of Birth
Gender
Preferred Contact Method
Would you like to be contacted via email about upcoming promotions and special events?
Address
How did you hear about Salt Spa Wellness?
Have you ever had or experienced any of the following conditions?
Are you currently experiencing any of the following?
Are you currently using or have you recently received a nerve block or other treatment that limits your ability to feel pain, heat, or pressure?
In the past year, have you had any of the following services? (Select all that apply)
Substance Use / Impairment Policy: I agree not to use Salt Spa Wellness services while impaired by the use of alcohol, recreational drugs, controlled substances, or any medication or substance that may impair my judgment, balance, coordination, or ability to safely participate. I understand that Salt Spa Wellness reserves the right to refuse, delay, or discontinue service if staff believes I may be impaired or if providing service may create a safety risk. Bookings affected by this policy may be subject to Salt Spa Wellness cancellation policies.
I understand that I can't float if I have dyed your hair in the last 14 days? (up to a month if a vibrant color) (Please note there is a $2,000 fine for bleeding hair dye which will damage our tanks)
I understand that I can't float if I have used any spray tan or self tanners in the last 5 days? (Please note there is a $2,000 fine for dye damage to the tanks)
I understand that we do not recommend floating if you have gotten a tattoo or piercing in the last 4-6 weeks? (We highly recommend these be fully healed before participating in any of our services.)
Are any minors (under 18) accompanying you today and participating in services?

This Release and Waiver of Liability ("Agreement") is entered into between Salt Spa Wellness (the "Company") and the undersigned client (the "Client") who desires to engage in services offered by the Company. This Agreement is intended to release and discharge the Company from any and all liability for personal injuries, property damage, or other claims that may arise from participation in services provided at Salt Spa Wellness.

FLOAT THERAPY

  • I understand that float therapy involves floating in a high-concentration Epsom salt solution.
  • I may experience skin sensitivity or tingling sensations, especially if I have recently shaved.
  • I will not float if I have had recent hair dye that bleeds, spray tans, or any contagious conditions such as open wounds or infections.
  • I understand there is a risk of slipping on wet surfaces and agree to use caution.
  • I acknowledge that any contamination of the float tank may result in a cleaning and salt replacement fee of up to $2,000.
  • I am not under the influence of drugs or alcohol and will follow all hygiene and safety protocols.

INFRARED SAUNA AND RED LIGHT THERAPY

  • I acknowledge that infrared sauna and red light therapy may elevate body temperature and carry risks such as dehydration, dizziness, or overheating.
  • I do not have any conditions (e.g., cardiovascular issues, heat sensitivity, metal or silicone implants) that would make sauna use unsafe unless cleared by a medical provider.
  • I will consult my doctor regarding any medications I am taking that may affect my bodyโ€™s response to heat (e.g., diuretics, beta-blockers, antihistamines).
  • I understand that children are more sensitive to heat and that pediatrician consultation is recommended before use.

SALT THERAPY (HALOTHERAPY)

  • I understand that salt therapy involves breathing in dry salt aerosol particles, which is not a substitute for medical treatment.
  • I may experience temporary side effects such as coughing, dry throat, or nasal drip as my respiratory system clears.
  • I will inform the staff if I experience shortness of breath or skin irritation.
  • I do not have any contraindicated conditions such as tuberculosis, contagious disease, cancer, fever, or other respiratory complications.
  • I understand this therapy is not a cure and is not FDA-approved.

AQUA MASSAGE

  • I understand that Aqua Massage uses heated, pressurized water jets through a protective barrier.
  • The massage may cause discomfort if I have conditions such as circulatory issues, varicose veins, infections, or inflammation.
  • I will consult a physician if I have any conditions where heat or massage may be harmful.
  • I will exercise caution when entering or exiting the equipment to prevent dizziness or falls.

GENERAL TERMS APPLICABLE TO ALL MODALITIES

  • I understand that the services provided are not intended to diagnose, treat, cure, or prevent any disease.
  • I acknowledge that I am voluntarily participating in these services and assume full responsibility for any injury or loss that may result.
  • I agree to follow all instructions, guidelines, and safety procedures provided by the Company and its staff.
  • I understand that failure to disclose relevant health information may increase the risk of injury.

I HEREBY EXPRESSLY WAIVE AND RELEASE ANY AND ALL CLAIMS, NOW KNOWN OR HEREAFTER KNOWN, IN ANY JURISDICTION AGAINST SALT SPA WELLNESS, AND ITS OFFICERS, EMPLOYEES, AGENTS, HEIRS, AND AFFILIATES (COLLECTIVELY, "RELEASEES"), ARISING OUT OF OR ATTRIBUTABLE TO MY PARTICIPATION IN THE SERVICES, WHETHER ARISING OUT OF THE NEGLIGENCE OF THE COMPANY OR OTHERWISE. I COVENANT NOT TO MAKE OR BRING ANY SUCH CLAIM AGAINST THE COMPANY OR ANY OTHER RELEASEE.

MAINE GOVERNING LAW CLAUSE

This Agreement shall be governed by, and construed in accordance with, the laws of the State of Maine, without regard to its conflict of laws principles. Any disputes arising under or in connection with this Agreement shall be subject to the exclusive jurisdiction of the courts located in the State of Maine.

REFUNDS

  • All sales are final; refunds are not provided for any reason.
  • A valid service purchase is required to reserve an appointment. This payment holds your reservation and will not be refunded in the event of cancellation or no-show.
  • You are welcome to reschedule your appointment in accordance with our rescheduling policy.
  • Any purchased services will remain on your account as a service credit, which can be used or transferred to another user. Credits expire one year from the date of purchase.

RESCHEDULING & CANCELLATIONS

  • Rescheduling is permitted with a minimum of 24 hoursโ€™ notice. To reschedule your appointment please log in to your account or call our front desk at 207-910-5100.
  • If you need to cancel in advance, your prepaid service credit will remain on your account and may be used to reschedule at a future date. Refunds are not issued.
  • Late cancellations (less than 24 hoursโ€™ notice) or no-shows will be considered a cancellation and will result in a cancellation fee equal to the full cost of the service that was scheduled. If you have a float or service credit on your account, it will be applied as your cancellation fee.
  • We understand that life happens. If youโ€™re unable to attend your appointment, you may send someone in your place to avoid the cancellation fee.

TEXT MESSAGE CONSENT

By providing your phone number and opting in to receive text messages, you consent to receive transactional SMS communications from Salt Spa Wellness related to your appointments. These messages may include appointment confirmations, reminders, arrival instructions, and notifications regarding last-minute appointment availability. Message frequency varies. You may opt out at any time by replying STOP. Reply HELP for assistance.

I acknowledge that I have read and fully understand this Agreement. I am signing it freely and voluntarily. I represent that I am at least 18 years of age, or, if signing on behalf of a minor, that I am their legal guardian and consent to the above terms on their behalf.
Clear Signature