Spa Pre-Treatment Questionnaire
Full Name
Date of Birth
Contact Number
Email Address
Medical History
Do you have any of the following?
Heart Condition
High Blood Pressure
Diabetes
Asthma
None
Are you currently taking any medication?
Yes
No
If yes, please specify
Are you pregnant?
Yes
No
Do you have any allergies?
Yes
No
If yes, please specify
Treatment Preferences
Preferred Treatment
Massage
Facial
Body Treatment
Other
What are your goals for today's visit?
Additional Notes or Concerns