Spa Screening Form

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

        Email

          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

            • Massage Therapy (e.g., Swedish, Deep Tissue, Hot Stone)

            • Facial Treatments (e.g., Anti-aging, Hydrating, Acne Treatment)

            • Body Scrubs or Wraps (e.g., Exfoliating Scrub, Detox Wrap)

            • Manicure/Pedicure

            • Aromatherapy or Relaxation Therapy

            Emergency Contact

            Name

              Emergency Contact Phone Number

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