Client Health Intake & Informed Consent

Welcome to our spa. Because many of our services involve direct contact with the skin, heat, pressure, essential oils, or chemical products, we need a clear picture of your current health before we begin. Everything you share stays in your confidential client file.

Section 1 — Your Details

Full name (as on ID):

Preferred name / pronouns:

Date of birth:

Mobile phone:

Email (for appointment reminders):

Emergency contact (name & phone):

How did you hear about us?

Section 2 — Medical Conditions

Please tick anything that applies now or in the past 12 months. These may require a modified treatment or written clearance from your doctor.

High or low blood pressure

Heart condition, stroke, or pacemaker

Diabetes (Type 1 or Type 2)

Blood thinners / anticoagulants (e.g. warfarin, aspirin daily)

Blood clotting disorder, DVT, or varicose veins

Pregnant or trying to conceive (weeks pregnant, if known):

Currently breastfeeding

Cancer or currently undergoing chemotherapy / radiation

Epilepsy or seizure disorder

Osteoporosis, recent fractures, or joint replacement

Surgery in the past 6 months (please describe below)

Skin condition (eczema, psoriasis, rosacea, dermatitis, open wounds)

Contagious skin or nail infection (fungal, herpes, warts)

Autoimmune condition (lupus, MS, rheumatoid arthritis)

Anxiety, PTSD, or sensitivity to touch (please note below)

Current medications (prescription & supplements):

Anything else our therapist should know (past injuries, recent illness, areas that feel tender):

Section 3 — Allergies & Sensitivities

Nut / almond oil (used in many massage blends)

Coconut / jojoba / grapeseed oil

Essential oils (lavender, peppermint, eucalyptus, citrus)

Latex

Fragrance or perfumes

Acrylic / gel / acetone (nail services)

AHA / BHA / retinoids / fruit acids (facials)

Other allergies (please specify):

Section 4 — Informed Consent

Please read each statement and tick the box to confirm you understand and agree.

I understand that spa services may involve disrobing, draping, and direct skin contact. Only the area being worked on will be uncovered; I may ask for additional draping at any time.

I understand that massage therapy and body work are NOT a substitute for medical diagnosis or treatment, and that my therapist is not a licensed physician.

I agree to tell my therapist immediately if any pressure, temperature, or product causes discomfort, pain, or an adverse reaction.

I have disclosed all health conditions, medications, and allergies I am aware of. I accept that withholding this information may affect service safety.

I understand nail and skin services carry a small risk of irritation, allergic reaction, or minor cuts, and I release the spa from liability for reactions caused by undisclosed sensitivities.

I consent to the spa keeping photographs of my nails / skin (before and after) for my client record only — not for public use — unless I separately opt in.

I have read, understood, and agree to the spa’s 24-hour cancellation policy.

Thank you for trusting us with your wellness. See you soon.

Spa & Beauty Wellness

Client Health Intake & Informed Consent

Section 1 — Your Details

Section 2 — Medical Conditions

Section 3 — Allergies & Sensitivities

Section 4 — Informed Consent

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