Your Name *

First Name

Last Name

Your Mobile Number

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Emergency Contact Phone

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Cryotherapy Appointment Type (If Applicable)

Please check the cryotherapy treatment you are interested in:

Whole Body Cryotherapy

Local/Target Cryotherapy

CryoFacial

Cryotherapy Contraindications

Please note if you check any of these boxes you cannot participate in cryotherapy:

High Blood Pressure <165 or higher

Currently Pregnant

Raynaud's Syndrome