Termination Request Form – Dual Platinum

Dual Platinum Membership Termination Request

You are currently enrolled in our Dual Platinum agreement which requires a 30-day notice to terminate. This form is a request. Please wait for an email confirmation from your home spa acknowledging that this form will be accepted as your 30 day notice to terminate. Please note your due date as there will be a final payment processed. Any banked sessions you may have will only be accessible up until the date of termination (30 calendar days from today). If you have any questions or need to book appointments, please call your spa at 952.995.9595.

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone Number*
Email*
Home Spa*
How long have you been a member?*
Reason for termination?*
Documentation - Medical*
Note from health care provider, treatment plan, or documentation that requests discontinuing services for medical reasons. Membership will be terminated immediately upon receipt of documentation. There will be no further dues processed or access to any banked sessions.
Documentation - Moving*
Please upload proof of move: USPS.com change of address form, utility bill, moving truck receipt, or any other documentation from a 3rd party source with your name and new address. Membership will be terminated immediately upon receipt of documentation. There will be no further dues processed or access to any banked sessions.
Reason for termination?*
Why do you want to terminate at the end of your agreement?*