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Spa Client Intake
A one-off form so any therapist can look after you properly.
Your name
*
(required)
Email address
*
(required)
Phone number
*
(required)
Date of birth
*
(required)
Address
Emergency contact - name and number
*
(required)
Doctor's practice
Health
Do any of these apply to you?
*
(required)
Heart condition
High or low blood pressure
Diabetes
Epilepsy
Asthma
Thyroid condition
Arthritis
Osteoporosis
Circulatory problems
Autoimmune condition
Cancer treatment now or in the last year
None of these
Details of anything ticked
Medication you take
Injuries or surgery we should know about
Are you pregnant or have you recently given birth?
*
(required)
Select…
No
Pregnant
Given birth in the last 6 months
Not applicable
Skin and allergies
Skin type
*
(required)
Select…
Dry
Oily
Combination
Normal
Sensitive
Allergies and sensitivities
*
(required)
Any of these?
*
(required)
Eczema
Psoriasis
Rosacea
Acne
Cold sores
Recent tattoos
None of these
Your preferences
Preferred massage pressure
1
2
3
4
5
6
7
8
9
10
Very light
Very firm
What makes a treatment better for you?
*
(required)
Silence - no conversation
Happy to chat
Music
A warmer room
A cooler room
Extra blankets
No oil in my hair
Nothing on my face
Feet left alone
Anywhere or anything to avoid?
How often do you have treatments?
*
(required)
Select…
This is my first
Once or twice a year
Every few months
Monthly
More often
Anything you've particularly loved or disliked before?
Consent
The information above is accurate and I'll tell you if it changes
*
(required)
I'll speak up during a treatment if anything is uncomfortable
*
(required)
Send me offers occasionally
Leave this field empty
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