Float Tank Release Form

Phone Number *
Phone Number
Address *
Address
Physician Phone Number
Physician Phone Number
Emergency Contact Phone Number *
Emergency Contact Phone Number
To ensure a comfortable, clean, safe floatation experience, I agree to the following: *
(by checking the box, you are legally acknowledging the following information to be true)
*If yes, please describe
If yes, please list medication, dosage, and condition:
Please check if you have or have had any of the following: *
This does not disqualify you from enjoying our therapy. It allows us to be more attentive to your own experience.
*Otherwise ignore
I understand that the Floatation Tank uses: *
*Please Sign:
Date *
Date