New Client Form – Bucktown

BUCKTOWN

*First Name
*Last Name
*Email
*Receive emails
*Address Street 1
*Address Street 2
*Address City
*Address State
*Address Postal Code
*Birthday
*Gender	Not SpecifiedMaleFemale
*Emergency Contact Name
*Emergency Contact Relationship
*Are you under medical care for any reason?
*If YES, please provide details?
*Allergic To Cold Temperatures?
*Blood Clots?
*Heart Disease?
*High Blood Pressure?
*Pregnant?
*Reynaud's Syndrone?
*Stroke?
*Medications ?
*How did you hear about The Cryobar?

ONLY $40

Hey Chicagoans, book your first chill today!

Lincoln Park
1205 W Webster Ave, Suite 1
Chicago, IL 60614
773-360-1729
Hours

Monday – Friday: 11AM – 6PM
Saturday: 10AM – 2PM
Sunday: 10AM – 2PM

West Loop
1215 W Madison St.
Chicago, IL 60607
312-720-5694
Hours

Monday - Friday: 11AM – 6PM
Saturday: 10AM – 2PM
Sunday: 10AM - 2PM

The CyroBar
1205 W Webster Ave, Suite 1
Chicago, IL 60614
773-360-1729
Hours

Monday & Sunday:
Tuesday-Friday:
Saturday: