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  • Spa Client Intake Form

  • Patient Data

  •  -
  •  -
  • Medical / History Data

  • If yes, please describe skin irriations-

  • Authorization

    • I confirm that all information given in this form is true, complete, and accurate.

    • I released this organization for any responsibility in case of accident, illness, or injury.

    • I acknowledge that no assurance was offered about the outcome.
  • Clear
  • Clear
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  • Should be Empty: