Michelle's Hidden Spa Massage Therapy Client Intake

Date

Full Name

First NameLast Name

Referred By:

Google, Facebook, Yelp, etc.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

E-mail

Birth Date Month & Day

Emergency Contact

Phone Number

Occupation

Where are you having pain or tightness?

Describe Onset of Discomfort or Pain

List all related treatments received for this injury and did it help

If you could waive a magic wand how would you like to feel within one month?

Is there anything that you do that creates, increases or decreases pain?

What activities/hobbies do you enjoy?

Any areas you do NOT want massaged?

Any special requests today? (CBD, body scrub, foot & hand treatment, aromatherapy, mini facial)

Any scents you absolutely love or dislike?

What kind of pressure do you like? Light to firm pressure, deep

Medical, Health, Bodily Conditions: Is there anything I need to know before we get started? The more I know, the better your experience. (Please List: allergies, sensitivities, pregnancy, stress level, health issues, diabetic, medications, metal plates.

What did you LOVE about your last massage and what could you have lived without?

Anything else you want to share? I love learning about my clients as it helps me provide superior customer service.

I understand that Michelle’s Hidden Spa services including facials, massages, and body treatments given at Michelle’s Hidden Spa, are for the sole purpose of skin cleansing, body, and mind relaxation and rejuvenation.

I agree

I understand that it is imperative to tell my Massage Therapist about any oral or topical medications prior to any facial, body treatment services, or massage.

I agree

I understand that Michelle’s Hidden Spa and staff do not diagnose illness, diseases, or any other physical or mental disorder. I accept full responsibility of the use of Michelle’s Hidden Spa at my own risk, and to not hold Michelle’s Hidden Spa or staff liable for loss, damage, or injury.

I agree

I understand that results are personable and not guaranteed.

I agree

I confirm that to the best of my knowledge that the answers given on client consultationt form are correct and that I have not withheld any information that maybe relevant to my treatment at Michelle’s Hidden Spa.

I agree

I understand that I must provide at least 24 hours advance notice for the cancellation of an appointment.

I agree

I understand Michelle’s Hidden Spa has a strict 24 Hour Cancellation Policy. In the event of a late cancellation/no show the fee is full price of the service. Card will be charged for the no show and late cancellation. Gift certificates will forfeit gift certificate for late cancellation and no show. For packages you will lose one of your sessions for no show and late cancellation.

I agree

Late arrivals may result in a shortened treatment time to ensure the next guest is not delayed. The full amount of service will still be charged.

I agree

Clients who frequently reschedule their appointments at the last minute, three or more times, may be subject to termination of services.

I agree

• You will be draped and at no time will genitalia or breast tissue be exposed

I agree

• Inappropriate behavior will not be tolerated and may be prosecuted to the full extent of the law

I agree

I also undersand that at any time I feel pain or discomfort during the session, I will immediatelyu inform my therapeutic massage therapist so they adjust.

I agree

*Please note any additional information that may be of importance to your Licensed Massage Therapist regarding the spa treatment you will be receiving.

After hitting submit please go ahead and book your appointment. All Booking is done online. www.michelleshiddenspa.com

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Date