Consultation form - ThorntonHallHotel.com

Name*:

What date is your spa treatment:

Contact Phone Number:

Date of Birth:

Email address:

Have you visited our Spa Before?:

How Often Do You Receive Treatments?:

What Pressure Do You Prefer During A Massage Treatment?:

What Brand Of Products Are You Currently Using?:

Have you had any surgery within the last 12 months? If yes please specify:

Please advise if you are currently pregnant? Yes No

Please advise if you currently have cancer or have undergone any cancer treatment in the past Yes No

Are you currently taking any medication? If yes please list:

Your Permission - I certify that the above statements are true and correct. My clicking submit, constitutes my acknowledgement that I have read, fully understand and fully consent to the proposed treatment. I hereby give my consent and authorisation that release Thornton Hall Hotel and its agents of any claims that I have in the future in connection with the described treatment. I hereby consent to the use of my personal data (including sensitive personal data) for the purpose of my treatment and any further treatment and confirm that any treatment is at my own risk without limiting or affecting my own statutory rights I may have.

Consultationform

Consultation
form