Spa Client Consultation FormTo save time before your consultation, simply fill out our Client Consultation Form. We will be ready for you when you arrive! Alternatively, download the form PDF, print it out and fill it in before you come to our SPA. WHY WE ASK WHAT WE ASK: We want to ensure that you are safe and comfortable for the duration of your treatment. Some questions are optional, however we ask that you are as transparent as possible.Name and Surname *Email Address *Phone *Date of treatment *Have you filled out this form in the past? *Yes, I have.No, I haven't.Has anything changed since last time you visited us? Have you started smoking, taking new medication or are you pregnant? *Nothing has changed.I have started smoking.I have started taking new medication.I am now pregnant.Other.If other, what has changed?New Client FormLet's find out a bit more about you, and what you need from your treatment. * NOTE, This form accommodates those coming for more than one treatment, and will be used for future treatments. Simply fill in the details from the top down and we will keep a record for you, so you won't have to fill it in again.Why are you coming into the spa today? *Have you had a Facial Treatment before? *YesNoIf yes, how recently?Do you have any skin conditions we should be aware of? *YesNoIf "yes" please specify. *Have you ever had an allergic reaction to any skin products? *YesNoIf "yes" please specify. *What skin areas are you concerned about? *Face & NeckBack & ShouldersHips/ Stomach areaLegs/ Back of LegsOtherNone of the aboveThis could include excessive oiliness, dryness, breakouts or other conditions on:Please tick if any of the following is applicable to you. *I have used Alpha Hydroxy Acid (AHA) or glycolic products in the past 48-72 hoursI am using Retin-A, Renova, Accutane or related products.I am using other skin tightening products and/or medication that thins blood.I am a diabetic.I bruise easily.None of the above are applicable.Are you currently taking any medication for the following: Diabetes, blood thinning, skin tightening, skin conditions/ acne etc. *THIS PART OF THE FORM IS APPLICABLE FOR WAXING TREATMENTSPlease fill this section in for potential future waxing treatments. Note that waxing can have certain side effects such as skin removal, redness, swelling, tenderness and so forth. We may ask personal questions as women are more sensitive to waxing just before your period, and skin is also prone to sensitivity if caffeine and alcohol have been consumed recently.What would you like us to achieve with your treatment?What is your Gender? *FemaleMaleOtherIf you're a female, and comfortable, when is your menstrual cycle due?THIS SECTION OF THE FORM RELATES TO GENERAL SPA TREATMENTSSpa packages, specials, pedicures, manicures & massage treatments.Do you have or have you had a history of any of the following, please select: *DiabetesHeart DiseaseCirculatory or Muscular DiseaseCancerAllergiesThyroid ProblemsHypertensionOtherNone of the aboveIf other, please specify.What type of treatment has been prescribed: *Please tick the options applicable to you: *I exercise regularly.I am pregnant.I am lactating.I am a smoker.None of the above.What is your general state of health recently? *Great!Good, but fatigued.Fatigued.Exhausted.Are there any areas where you are experiencing discomfort or pain currently? *Areas we should focus on?Your preferred treatment pressure, 1(one) being the lowest, 5(five) highest: *12345TERMS & CONDITIONSTerms & Conditions for the Spa can be found HERE on the first page of our Spa Menu. Please read through them before acceptingI have read the above information and have provided accurate information. If I have any concerns, I will address these with my beautician. I give permission to my beautician to perform the treatments we have discussed and will hold him/her harmless from any liability that may result from this treatment. I understand that my beautician will take every precaution to minimize or eliminate negative reactions as much as possible, an accept the Terms & Conditions of The Feather Hill's Day Spa. *YesSend Message
