Before Your Treatment

Discover the next level in wellness in our Whistler Spa with our Form

Please fill out The Spa at Nita Lake Lodge’s digital customer intake form to speed up the check-in process and reduce our paper waste.

Personal Information

First name*

Last name*

Email*

Address*

City*

Postal code

Phone number*

Emergency contact

Emergency contact name*

Emergency contact phone number*

Health Information

Are you pregnant? If so please indicate how many weeks along you are?

List any known allergies (Type N/A if not applicable)*

List any accidents or surgeries in the last 12 months (Type N/A if not applicable)*

List any medications you are currently taking (Type N/A if not applicable)*

For facials and waxing: are you currently taking Accutane or using a Retin-A/AHA?

Please read carefully and give your consent

I acknowledge and understand that a person can unintentionally spread COVID‐19 to others even if they do not feel sick or have symptoms.

I acknowledge and understand that my therapist, the staff, this business, or the owner of this business cannot completely control the spread of COVID‐19 and I have chosen to enter this business and consent to receive close contact service(s) with full knowledge of the risk of contracting COVID‐19 when social distancing is not observed.

I acknowledge and understand that I should not attend my spa appointment if I am experiencing any symptoms of COVID-19.

Because we are all in this together, all employees of The Spa at Nita Lake Lodge also acknowledge and agree to these same standards and statements every day. By ticking the box above, I agree not to hold my therapist, the staff, this business, or the owner of this business liable for any exposure to COVID‐19 while at the Spa at Nita Lake Lodge.

I acknowledge and understand that there are risks associated with services provided by The Spa at Nita Lake Lodge. Examples may include but are not limited to; bruising, aching, discomfort, short term aggravation of symptoms, and skin irritation. I acknowledge that my participation in these treatments is entirely voluntary.

I agree to discuss my concerns about possible risks with my therapist before the treatment and immediately advise them if I become uncomfortable in any way during my treatment.

I acknowledge and understand that it is important for the therapist to know my relevant medical history and that I have disclosed all known medical conditions, including any mental or emotional conditions for which I have received treatment within the last 12 months.

I will disclose any new condition that may develop after my completion of this form. The information disclosed by me is true and complete to the best of my knowledge.

I authorize copies of any patient record created at The Spa at Nita Lake Lodge to be shared with all registered professionals who work at The Spa at Nita Lake Lodge who may provide me with treatment.

I understand this will enable The Spa to maintain a complete patient record on my behalf. I understand that I may revoke this permission in writing at any time in the future.

I acknowledge inappropriate conduct of any nature will not be tolerated and may result in the treatment being terminated.

I assume all risks involved in my participation in the services provided by The Spa, its employees and spa therapists. I agree to release and forever discharge The Spa at Nita Lake Lodge, its owners, its directors, employees and contractors from any claims, losses, damages, actions or causes of action arising out of any loss, injury, damage to my person or property arising from my involvement with the services provided by The Spa at Nita Lake Lodge.

The contents of this form and my patient records will be kept confidential unless I have expressly or impliedly consented to the release of my information or, where there is a legal requirement to provide my information to a third party.

I acknowledge and confirm that no guarantee or assurance of treatment results have been made to me regarding my services provided by The Spa at Nita Lake Lodge.