Name
*
First Name
Last Name
Preferred Name:
Date of Birth
*
Birthday
MM
DD
YYYY
Preferred Pronouns (EX: She/Her)
Email
*
Phone
*
How did you hear about us?
Instagram
Google
Facebook
Friend/Family
Other
Occupation
*
Are you currently under any medical care or have an injury we need to be aware of? Please describe
*
Please list any allergies:
*
Have you ever had complications during a massage, body treatment, facial, waxing or nail service?
*
Please indicate if you have any medical conditions or communicable diseases:
*
Do you have foot fungus?
*
Due to foot fungus being highly contagious, we are unable to provide foot treatments if you have foot fungus.
Do you have athlete’s foot?
*
Are you currently under the care of a podiatrist?
*
If you are pregnant, how far along?
Have you ever had a professional massage, facial or body scrub/wrap?
*
What type of massage pressure do you prefer?
*
Light
Medium
Deep
Are there any areas of your body you would like us to avoid?
*
To benefit the most from your treatment, please list areas or concerns you would like your spa provider to give attention to:
*
What are your skin care concerns/sensitivities? Please list any doctor prescribed medications for skin. What products are you currently using?
If you are receiving a facial, please provide the most information you can.
If I am receiving an Advanced Facial or Skin Peel I understand:
We want to ensure your experience is exactly what you want! Please tell us if you generally enjoy a social or silent treatment. You will have the opportunity to select the day of if it changes from day to day.
As A Guest Of Blooming Moon Spa:
*
