Guest Wellness Intake Form

To ensure a personalized and relaxing experience, please take a few moments to share the following information with us. All personal and health information provided is kept strictly confidential and used only to ensure a safe and customized spa experience.

Wellness Intake Form
GUEST INFORMATION
GUEST INFORMATION
First Name
Last Name
Emergency Contact
Emergency Contact
First Name
Last Name

TODAY’S VISIT:

Treatment(s) scheduled today: (check all that apply)
What would you like to focus on during your treatment today?

WELLNESS & HEALTH INFORMATION:

For your safety, please indicate any conditions that apply to you:

ALLERGIES & SENSITIVITIES:

Do you have allergies to any of the following?
Skin type (for facial services):

PERSONAL COMFORT PREFERENCES:

Massage pressure preference:
Aromatherapy preference:

WELLNESS GOALS:

How are you feeling today?
GUEST CONSENT:

I confirm that the information provided above is accurate to the best of my knowledge. I understand that spa services are intended for relaxation and wellness purposes and are not a substitute for medical treatment.

I agree to inform my therapist of any changes in my health or comfort during the service.

I confirm that I am at least 18 years of age or have consent from a parent or legal guardian.

By typing your name you are providing your legal and authorized signature.
THERAPIST NOTES: