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Your Health

is our

#1 PRIORITY! 

Under Governor Abbott's plan to Open Texas, certain services and activities are allowed to open with limited occupancy. C4Cryo is able to do so as of May 8th.

As we are thrilled to be back in business, there are some restrictions when it comes to services. 

-Maximum of 4 customers allowed in the store at a time.

-Paying customers ONLY (If you are not doing any services, you MUST remain outside the store).

-We are NOT accepting cash at this time.

-We are only offering select services including Whole Body Cryo and Locals. We are offering NormaTec and Facials by appointment only. 

 

We ask that you do wear a mask as out staff is trained to do so as well, and please sanitize upon entering the store. Once you enter you are asked to fill out this

wavier to ensure you have not been exposed to COVID-19. C4Cryo has the right to refuse any business. C4Cryo is not responsible if COVID-19 is contracted while in our store.

 

Please take a quick minute to fill out this waiver to ensure the safety of our customers and employees. 

 

First Customers Name

First Name*

Last Name*

Phone*
First Customers Date of Birth*
I certify that I am 17 years of age or older
First Customers COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
First Customers Signature*
Second Customers Name

First Name*

Last Name*

Phone*
Second Customers Date of Birth*
Second Customers COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
Third Customers Name

First Name*

Last Name*

Phone*
Third Customers Date of Birth*
Third Customers COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
Fourth Customers Name

First Name*

Last Name*

Phone*
Fourth Customers Date of Birth*
Fourth Customers COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
Fifth Customers Name

First Name*

Last Name*

Phone*
Fifth Customers Date of Birth*
Fifth Customers COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
Sixth Customers Name

First Name*

Last Name*

Phone*
Sixth Customers Date of Birth*
Sixth Customers COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
Seventh Customers Name

First Name*

Last Name*

Phone*
Seventh Customers Date of Birth*
Seventh Customers COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
Eighth Customers Name

First Name*

Last Name*

Phone*
Eighth Customers Date of Birth*
Eighth Customers COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
Ninth Customers Name

First Name*

Last Name*

Phone*
Ninth Customers Date of Birth*
Ninth Customers COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
Tenth Customers Name

First Name*

Last Name*

Phone*
Tenth Customers Date of Birth*
Tenth Customers COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 17 years of age or older
Parent or Guardian's COVID-19 Questionnaire
Have you experienced any shortness of breath or difficulty breathing?*
Have you recently experienced any coughing?*
Have you recently experienced any muscle soreness?*
Have you recently experienced a fever?*
Have you recently be around or near anyone who has experienced any of the following symptoms: Fever, coughing, shortness of breath or muscle soreness?*
Have you traveled outside of the state or country recently?*
Have you been around anyone who has traveled outside of the state or country recently?*
Have you been in an airport recently?*
Have you been around anyone who has been in an airport recently?*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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