Replace this text with your company's privacy policy.

Loading...

Please respond to each item.

Before Flowpresso Therapy...


Review The Primping Place Privacy Policy

When coming in for your Flowpresso treatment please wear long pants, long sleeve top & socks and hydrate well before. 

I Agree

Please select who will be participating...
AdultMinor
Continue
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Do you have quality sleep? (Consistent, 8 hours)
n/a
not at all (1)
a little bit (2)
somewhat (3)
quite a bit (4)
very much (5)
Do you struggle with fatigue?
n/a
not at all (1)
a little bit (2)
somewhat (3)
quite a bit (4)
very much (5)
Do you struggle with anxiety?
N/A
Not at all (1)
A little bit (2)
Somewhat (3)
Quite a bit (4)
very much (5)
Do you have a stressful lifestyle?
n/a
not at all (1)
a little bit (2)
somewhat (3)
quite a bit (4)
very much (5)
Do you suffer from headaches?
n/a
not at all (1)
a little bit (2)
somewhat (3)
quite a bit (4)
very much (5)
Do you consume enough water each day? (2 litres / 1/2 gallon?)
n/a
not at all (1)
a little bit (2)
Somewhat (3)
quite a bit (4)
very much (5)
Do you have muscular pain?
n/a
not at all (1)
a little bit (2)
somewhat (3)
quite a bit (4)
very much (5)
Do you have digestion issues?
n/a
not at all (1)
a little bit (2)
somewhat (3)
quite a bit (4)
very much (5)
First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Do you have a healthy libido?*
n/a
not at all (1)
a little bit (2)
somewhat (3)
quite a bit (4)
very much (5)
Do you struggle to relax?*
n/a
not at all (1)
a little bit (2)
somewhat (3)
quite a bit (4)
very much (5)
Do you lead an active lifestyle?*
n/a
not at all (1)
a little bit (2)
a little bit (3)
quite a bit (4)
very much (5)
Do you work long hours?*
Yes
Sometimes
No
Are you a shift worker?*
Yes
No
First Participant's Signature*
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.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Do you have a healthy libido?*
n/a
not at all (1)
a little bit (2)
somewhat (3)
quite a bit (4)
very much (5)
Do you struggle to relax?*
n/a
not at all (1)
a little bit (2)
somewhat (3)
quite a bit (4)
very much (5)
Do you lead an active lifestyle?*
n/a
not at all (1)
a little bit (2)
a little bit (3)
quite a bit (4)
very much (5)
Do you work long hours?*
Yes
Sometimes
No
Are you a shift worker?*
Yes
No
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!