Spa Ritual Customization Master 2025

Name* This field is required.

First Name

Last Name

Have you had a professional facial or massage before? If yes, what did you like or dislike about it? * This field is required.

What would you like to achieve from your treatment today?* This field is required.

Do you have any special skin problems or concerns pertaining to your face or body? If yes, please explain:

Any changes to medications, medical conditions or home care regimen since you filled out your Health Intake Form? If yes, please explain:* This field is required.

Have you used any Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hours?* This field is required.

Yes

Not Sure

Type option 4

Other

Have you been exposed to the sun or used a tanning bed in the last 48 hours?* This field is required.

Yes

Please pick your top 3 skincare concerns from the list you would like addressed during your treatment.* This field is required.

If other, please explain:

What kind of experience would you like to have?* This field is required.

I would like to focus on my skin concerns using gadgets & gizmos

I just want to sink into deep relaxation

I will leave it up to you

I would like to address my skin concerns but also relax

I want all the Woo Woo

What best describes your sleeping temperature level:* This field is required.

My blanket is always off me

I have personal summers (menopause), so I adjust throughout the night

I sleep with one foot out for temperature regulation

I'm like an igloo, I am always freezing

Let's customize your Environment:* This field is required. Select all that you'd like to experience. However, this does mean you will experience all that are checked.

15 Pound Weighted Blanket

Heated Table Matt

Scalp/Neck/Shoulder Massage

Aromatherapy/ Deep Breathing /Energy Work

Realignment Tricks

Intention/ Tarot or Crystals Cards sounds amazing

PEMF (Pulsed Electromagnetic Field Therapy) is not for those with pacemakers, pregnant or metal implants

I will let Spa Liz decide

I wouldn't like to try any of these things

Let's customize your Enhancements:* This field is required. Select all that you'd like to experience. However, this does mean you will experience all that are checked.

Hand Moisturizing Treatment with Warm Mittens

Foot Moisturizing Treatment with Warm Booties

Elevated Hand Enzyme with Moisturizing Mask Treatment & Heated Mittens (+$8)

Elevated Foot Enzyme with Moisturizing Mask Treatment & Heated Booties (+$8)

Chakra Realignment

Crystal Intention Layout

Energy Work

Lip Sheet Mask (+$5)

Face Sheet Mask (+$5)

LED (Light Emit Device) Therapy *great for anti-aging & acne

I will let Spa Liz decide

I wouldn't like to try any of these things

What best describes your interest in Energy Work?* This field is required.

Never have tried any "new age stuff" and don't care to

Have tried some and would like to experience more

Give it all to me, my chakras are whacked

My massage oil choice would be:* This field is required.

I prefer no aromatherapy

Lavender Essential Oil

Vanilla Essential Oil

Blushing Agave® (light and delicious, and reminiscent of red berries and cream)

Clementine Body Oil (refreshing dreamsicle of ripe clementine oranges and a hint of cream)

Citrus Cilantro Body Oil (a refreshing and light cut-grass scent)

Agave Nectar Body Oil (light – an oat/milk scent, comparable to a to-die-for tiramisu dessert)

Juniper Ale Oil (scented fresh greens, bergamot & orange. Infused with lemon balm & juniper)

Quinsyberry Oil (light – an apple blossom & tea note)

Red Hot Body Oil (sultry-sweet gingerbread aroma)

Citrus & Lavender Massage Butter

If I had to pick 2 areas to focus on during my massage, they would be:* This field is required.

Face

Scalp

Hands/Forearms

Feet

Neck/Shoulder

Full Back (only available in the 90 minutes)

If there is any area you would like to avoid, pressure preference, ticklish area, or anything you think I should know about your massage preference, please describe below.

What one phrase would you like to walk away from this experience having thought?* This field is required.

Wow, I am truly relaxed

My skin looks beautiful and my body tension has melted

I can't believe I haven't experienced this before, I will be back next month

It was everything and even more than what I expected, exactly what I needed

The combo of energy work, relaxation and my skin feeling fabulous is what I have been looking for

I understand, have read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I am aware that it is my responsibility to inform the esthetician/skincare therapist of my current medical or health conditions and update this history. The treatments I receive here are voluntary, and I release this institution and/or skincare professional from liability and assume full responsibility thereof.

By signing below, I understand and agree to all the above information.Clear* This field is required.

Clear