Health declaration

Please fill out the following form.

First name

Last name

Email

Date of birth

Day

Month

Year

Have you been hospitalised in the last 12 months?

No

Yes

Are you suffering from a medical condition, illness or injury?

No

Yes

If you answered yes to any of the questions above, please supply additional information.

Please give the name, relationship to you and phone number of next of kin.

I confirm that I have received medical approval to use the sauna and hot tub. I understand the risks associated with heat exposure and accept full responsibility for my participation.

Initials

I declare that the info I’ve provided is accurate and complete.

Nurtured Soul

Health declaration