Free Spa Screening Form Template
Spa Screening Form
Please complete this form to ensure a safe and personalized spa experience tailored to your health and preferences.
Name
Date of Birth
Phone number
Do you have any allergies?
Do you have any existing medical conditions?
Are you currently pregnant or breastfeeding?
Are you taking any medication?
Do you have any skin sensitivities or conditions?
Preferred treatments or services
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Massage Therapy (e.g., Swedish, Deep Tissue, Hot Stone)
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Facial Treatments (e.g., Anti-aging, Hydrating, Acne Treatment)
-
Body Scrubs or Wraps (e.g., Exfoliating Scrub, Detox Wrap)
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Manicure/Pedicure
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Aromatherapy or Relaxation Therapy
Emergency Contact
Name
Emergency Contact Phone Number
Thank you for submission!
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