Spa Client Intake Form
Spa Client Intake Form
Name
Date of Birth
Phone number
Address
Medical History
Are you currently under a doctor’s care?
Do you have any chronic conditions? (e.g., diabetes, hypertension) If yes, please specify.
Have you had any recent surgeries or medical treatments? If yes, please specify.
List any medications you are currently taking.
Do you have any allergies? (e.g., medications, skincare products) If yes, please specify.
Skin and Body Concerns
What are your primary concerns or areas of focus? (e.g., acne, aging, dryness)
Do you have any specific skincare goals? If yes, please specify.
Are there any areas of your body that you prefer not to be treated? If yes, please specify.
Treatment Preferences
What type of treatments are you interested in? (e.g., facials, massages, body treatments)
Do you have any preferences regarding pressure or techniques used during treatments? If yes, please specify.
Have you had any previous spa treatments? If so, please specify
Consent and Acknowledgment
I,
Client's Name:
Date Signed:
Thank you for submission!
We appreciate you taking the time to submit.
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