CK Health Plus Registration

Step 1: Customer Information

Full Name (as per IC):

Date of Birth:

IC / Passport Number:

Phone Number:

Occupation:

Sex:

Address:

Preferred Language:

Emergency Contact’s Name:

Emergency Phone Number:

Relationship:

How did you find CK Health Plus?

Step 2: Medical History Questionnaire

When was the last time you were in the hospital and why?

Any previous/current medical conditions and/or feeling of unwellness?

Are you allergic to any medication or food? If yes, please specify.

Are you currently undergoing and/or planning to do any beauty treatment?

Are you taking any supplements currently?

14. On a scale of 1-10, how well can you tolerate heat?

Least heat resistant Most heat tolerant

15. On a scale of 1-10, how well can you tolerate massages?

Least massage resistant Most massage tolerant

16. Do you feel claustrophobic being confined for 45 minutes?

Step 3: Consent for Bioinformatics Capsule Spa Therapy

I, , authorize the therapist at CK Health Plus SDN BHD to perform Bioinformatics Energy Capsule Spa Therapy on me.

I understand that serious complications are extremely rare but possible. Common symptoms of improvement include irregular periods (only applicable for female customers), acne, pimples, pain, fatigue that may last temporarily.

I understand that inconsistent therapy, unnecessary covering of body surface, and incomplete therapy may result in failure to achieve the desired results. In the event that I request to stop therapy during the therapy session and once the capsule is opened, the session is deemed to be finished.

I understand that doing therapy in the state of un-wellness/injury/high blood pressure/recent operation or surgery, showering and direct air-conditioner exposure within 4 hours after the therapy are contraindicated and CK Health Plus SDN BHD is not liable for such conditions.

I have read, been explained, and understood as well as given the post-therapy instructions.

Signature:

Date:

Step 4: Terms and Conditions

All sales are final and non-refundable, and applicants are entitled to the packages as purchased.
All appointments made must be fulfilled, and in the event of cancellation, customer/user shall inform 24 hours ahead. All services/therapy sessions will be forfeited due to customer/user cancellation unless a valid reason can be provided with proof/police report.
Company will not take liability for any damages, accidents, or any belongings lost in the CK Health Plus premise. Use of all services/therapy are subject to the risk of customers.
All packages/therapy purchased have an expiry date of 3 months from the date of purchase.
Packages purchased are non-transferable, and in any special case of transfer, it is subject to approval from the management of the company.
Company has the full rights to suspend/terminate any referral accounts if found for any violations from the referrals.
Management of the company has the rights and discretion to change any of its policies without prior notice to customers/users.

Applicant’s Signature:

Date:

Referral’s Full Name:

Step 5: Signature and Final Submission

Please review all your information before submitting.