ZenYou Collection Intake Form

The ZenYou Collection - Client Intake Form :

To allow more time during our initial session please fill out this form prior to your appointment. As a clinical aromatherapist we provide treatments that promote relaxation, stress reduction and physical, emotional and spiritual wellbeing. We may also provide recommendations of therapeutic purpose if necessary. We do not treat nor diagnose disease or illness. If you are currently under the care of a medical team for any chronic conditions it is recommended you seek their guidance prior to adding aromatherapy. We will ask you several health related questions to ensure all essential oils used are safe for you and have no contraindication with any medical condition or medications. We are a member of the Alliance of International Aromatherapists and adhere to their code of ethics and conduct and professional practice. We are insured and accredited. We will always use the highest quality carrier oils and pure essential oils during your treatments.
Full Name *

First Name Last Name
Birth Date *

Month Day Year
Date
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Please indicate your gender.

Woman Man Trans I do not identify
Phone Number *

Area Code Phone Number
E-mail
After you book your session please add info@deannabyrne.com to your contact list in your email. We will communicate with you via email for appointment confirmations and updates. This will avoid our important emails going to your spam folder.

Please tell us if you have a preference for certain essential oils. If yes, please list them.
Please tell us if you do not like the smell of certain essential oils. If yes, please list them.
Are you currently seeing any other health practitioners?

Yes No
If yes, please tell us what you are being treated for and by whom.

We offer custom designed blends to enhance your session experience. Please choose the one that appeals to you.

ZenYou for Aches and Pains ZenYou for Calming ZenYou for Mood Elevation ZenYou to Relax Muscles ZenYou for Stress Relief ZenYou Foot Rejuvenator (Soul to Sole Foot Massage)
Are you redeeming a Gift Certificate?

Yes No
If a friend referred you please tell us their name
Friend's Name
Almost done!!

ZenYou Services In-Clinic Cancelation Terms:

We are a small boutique clinic, and in order to provide you and others with excellent customer service and access to appointments during peak times, we reserve that time just for you. Without sufficient notice, we end up turning away other clientele. When clients are unable to make their scheduled appointments, we are unable to best serve our customers waiting for that spot. We do travel from out of town for your appointment and share the space with other therapists. Our cancelation policy is set to accommodate this.

We will require a credit card number which we will call to get from you at the time of booking. Your card is not charged until your appointment. Those that do not have a credit card will be required to pay via etransfer for your appointment to be held.
- No-show appointments are 100% non-refundable. Your credit card on file will be charged.
- We require 48 hours' notice to cancel an appointment without penalty.
- 48 hours notice is required to cancel with the exception of a medical emergency. Your credit card will not be charged.
- Cancelations within 48 hours of appointment time require a 50% penalty fee of the cost of services booked.
- We do require a credit card at the time of booking. Your card is not charged until the day of your appointment.
- No-Show appointments will require full payment of services booked for secondary appointments.
- Late Arrivals: Our sanctuary is cleaned and disinfected between all clients. We require a minimum of 30 minutes between appointments to do this. Your appointment time will end at its scheduled time to allow this cleaning process to happen and to ensure the next client starts their appointment on time.
We understand that some things happen outside of your control that makes you late to your appointment. We will do everything we can to accommodate you. However, if you are running more than 5 minutes late we may need to offer you a shorter service or reschedule your appointment in order to accommodate all of our guests with the full ZenYou experience. Please let us know as soon as possible that you are running late so we can best accommodate everyone. If we have to reschedule your appointment, you will be responsible for 50% of the value of the original service(s).
Please click the SUBMIT FORM tab below. We will send you a copy of your form is you wish if you can print it below. We look forward to welcoming you into our wellness sanctuary.

See you soon!
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