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Donate
I can pay
Home
News and Events
Book Now
FAQ
Packages
Memberships
Client Details
Name
*
Name
First Name
Last Name
Address
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
Phone
(###)
###
####
Date of Birth
Date of Birth
MM
DD
YYYY
Gender
Male
Female
I'm not defined by gender labels
Email Address
*
Emergency Contact
Emergency Contact
Relationship
Emergency Contact Phone
Emergency Contact Phone
(###)
###
####
How did you hear about us?
What areas of your life do you hope floating will help improve?
Physical Goals
Increased Energy
Alleviate Physical Pain
Athletic Enhancement
Rapid Physical Recovery
Headache Relief
Lower Blood Pressure
Improve Sleep Quality
Speed Jet Leg
Mental Goals
Increase Motivation
Improve Concentration
Improve Problem-Solving
Increase Creativity
Increase Intuition
Meditation Practice
Personal Growth
Elevate Mood
Clinical Goals
Stress Relief
Reduce Stress-Related Illness
Depression Relief
Anxiety Relief
PTSD Symptoms
Fibromyalgia Relief
Eliminate Addictive Behaviors
Eating Disorder
Any additional goals not listed above?
If experiencing physical pain, where is the pain?
List anything that has not worked to relieve physical pain:
Are you currently taking any medications, supplements, or vitamins?
Yes
No
If yes, what and how often?
Please list any additional medical conditions:
Do you have any concerns while floating?
Thank you!
