Hands & Feet
Ambika Herbals CBD Collection
Clear My Head
WholeMade Bath Co
This intake form is for clients that have already reserved with us. If you would like to book a service please call us at 970-547-8701.
Date of Birth
Are you wearing contacts?
Are you pregnant?
How many weeks?
Medical Release for Prenatal Spa Treatments
Soothe Spa provides a variety of spa services, treatments, therapies and procedures. Certain Spa Treatments are not recommended for pregnant women during the first trimester of pregnancy, including massage therapy, body wraps, hot stone massage, reflexology and aromatherapy which are considered contraindicated services ("Treatments" used individually or collectively). If you are pregnant, it is suggested that you discuss receiving these services with your prenatal healthcare provider prior to receiving any such treatments.
I verify that I have discussed with my prenatal healthcare provider/physician any health concerns that I had about my participation in any Spa Treatments, including without limitation any contraindicated services listed above, and I understand and freely accept the potential risks of such Spa Treatments. I also understand that I am free to withdraw my consent and to discontinue participation in any Treatments at any time. Having read, discussed, and understood the above information, I further verify that I have obtained my prenatal healthcare provider's release and disclosed all high risk conditions of pregnancy. I do forever release the Spa, its therapists, practitioners, employees, agents, and each of their insurers, from all liability of any occur to of any nature whatsoever, whether past, present, or future for any injury or damage which may occur to myself or my family as a result of my participation in any Spa Treatments. I also agree to hold harmless and defend the Spa, its therapists, practitioners, employees and agents from all actions, claims, or other legal or administrative action that arises or may arise directly or indirectly out of my and my child's participation in any Spa Treatments.
I have read and accept the Prenatal Medical Release conditions
How did you hear about us?
For Massage Service
Have you had any of the following symptoms within the last 72 hours?
Shortness of Breath/Difficulty Breathing
Congestion or Runny Nose
Loss of Taste or Smell
Rash: Open Wounds; Warts (Hands/Feet)
I will keep my face covered for the duration of the service and in indoor areas open to the general public whenever six feet of separation cannot be maintained.
What areas would you like your therapist to concentrate on today?
Describe any physical complaints or problem areas:
Do you have any medical problems, previous/existing/chronic injuries, accidents or surgeries? If, so please describe them:
Do you have any allergies your therapist should be aware of (i.e. latex, coconut oil, nuts, etc.)?
Please list them:
I am least 18 years of age.
Currently we are not offering minors massage services at all due to Covid-19 restrictions. We are also not able to offer couples massages. We will have limited treatments and amenities available during this time, please call the spa for most up to date information. All minors under the age of 18 receiving a massage must have their parent/guardian in a service with them in the form of couple’s massage. We do not allow minors under the age of 10 to receive a massage. A parent/guardian of any child under 18 must provide written permission via the Soothe Spa Waiver and Consent form for the minor receiving a massage. The form must be signed and dated by the parent/guardian.
Minor Massage Policy
I have read and accept the Minor Massage Policy
Our staff is dedicated to providing a luxuriously tailored treatment for you. Please see our specialty upgrades. Please note these upgrades do not add additional time to your treatment.
Please select any specialty upgrades you would like to add to your service:
Quench Massage - $15
Collagen Eye Treatment - $12
CBD Spot Treatment - $20
CBD Full Body Massage - $30
Scalp Ritual - $12
Massage Treatment Consent
I certify that the above information is complete and correct. I will keep the therapist informed of any changes as they occur. I will be responsible For making payments on any appointment which is not cancelled 24 hours in advance. I understand that Breckenridqe Grand Vacations, Soothe Spa, and any therapist working at this business will not be liable For any injuries or loss sustained to myself or property at this location, and that the procedures I am receiving are not intended to be a substitute for professional medical treatment for any condition.
I agree to the policy
Massage Service Payment
I authorize Soothe Spa to charge the amount of my service to the credit card on file.
I understand that if I do not provide the appropriate cancellation window which is 24 hours in advance of my service my card will be charged for the full cost of service.
I agree to the policy
I would like to include a gratuity for my service provider:
AT THE GRAND LODGE ON PEAK 7
1979 Ski Hill Road
Breckenridge, CO 80424
Open every day, 8 a.m. - 10 p.m.
The soul of Breckenridge Grand Vacations is creating smiles!
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