Intake Form - Rancho La Puerta
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Rancho La Puerta > Intake Form

Intake Form

At The Ranch, you can relax and unwind, knowing that we are prepared to address your needs. We ask that all guests complete this intake form to help us ensure you have the best possible experience.

Please fill out and submit the form below in advance of your visit.

Medical Intake
Age range (optional):
Traveling Solo?

Medical

Do you have any walking issues or any condition that would impair your ability to walk independently throughout the property on uneven terrain that includes steps and ramps?
Do you have any medical condition that could be affected by participating in a fitness class or by receiving a spa service/treatment?
Are you taking any medication for any condition?
Have you had any injuries within the last year?
Have you had any surgeries, including cosmetic within the last year?
Do you have any skin conditions?
Do you have any implants (i.e. pacemaker, joint replacement, etc.)
Are you pregnant?

Dietary

Do you have any food intolerances, including allergies?
Do you have any dietary preferences?

Environmental

Do you have any allergies to soaps, fragrances, oils, skin care products, etc.?
Do you have any environmental or insect allergies?

Additional Information

 

If you have any questions, please email our staff physicians at firstaid@rancholapuerta.com or call them directly at 858-925-1214 ext. 630.