Spa Consultation Form

Upon booking your treatment with us, please take a moment to complete the spa consultation form below prior to your arrival. ( at least 48 hours before)
This will save time at check in and help speed up your personal consultation with your therapist before your treatment begins.

Personal Information





Female
Male









Medical Information

If you have any health conditions (whether or not listed below), we recommend that you proceed only with your doctors approval.
(See Our Recommendations)

Heart Conditions/Strokes
Cancer/Chemotherapy
High/Low Blood Pressure
Diabetes (Type 1 or 2)
Epilepsy
Hepatitis
Kidney/Liver Disorders
Thyroid Problems
Recent Operations including Laser Eye Surgery
Pregnancy/IVF/Breast Feeding
Depression/Anxiety
Poor Circulation
Water Retention/Oedema
Claustrophobia
Joint Problems/Hyper Mobility
Muscular Pain
Asthma
Varicose Veins/DVT/Thrombosis
Sclerotherapy
Iodine/Shellfish sensitivities
Food/Nut Allergies
Product Allergies
Skin Sensitivity/Allergies
Sunburn
Hormonal Imbalance
Acne/Rosacea
Psoriasis/Eczema
Recent Cosmetic Surgery
Botox/Restylane/Fillers/Collagen
Micro dermabrasion Chemical Peels
Use of AHA’s/Retinol Retin A/Roacutin
Foot Infections
Contact Lenses



Your Visit

Body Treatment
Facial Treatment
Clinical Treatment
Waxing Treatment
Manicure/Pedicure Treatment





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