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Spa Online Consultation Form
"
*
" indicates required fields
Name
*
First
Last
Email
Date of Birth
*
Day
Month
Year
Date of Treatment
*
Day
Month
Year
Time of Treatment
*
Hours
:
Minutes
Treatment Description (Treatment booked)
Phone
*
Please Indicate If You Are Suffering From Any Of The Following
*
Cancer
Any Lymph Nodes removed, radiated or Damaged?
Heart Condition
High / Low Blood Pressure
Recent Operation
Joint Problems
Muscular Pain
Seizures / Epilepsy
Thyroid Problems
Diabetes
Iodine Sensitivity
Poor Circulation
Skin Sensitivity
Allergies (Nut Etc.)
Product Allergies
Asthma
Psoriasis
Cuts, Bruises and Abrasions
Water Retention
Claustrophobia
Acne
Eczema
Warts
Verucas
None Of The Above
Other Please Specify
Other Please Specify
Are You Pregnant?
*
Yes
No
If Yes, How Many Weeks?
Are You Taking Any Medication Or Supplements?
*
Yes
No
If Yes To Any Of The Above Did You Consult A Doctor Or Medical Practitioner?
*
Yes
No
Lifestyle
Do You Smoke?
*
Yes
No
Do You Wear A Hearing Aid?
*
Yes
No
Do You Wear Contact Lenses?
*
Yes
No
What Is Your Current Home Skincare Routine? Please tick products you use:
*
Cleanser
Toner
Exfoliator
Day Cream
Night Cream
Eye Product
Face Masks
Serum
Body Exfoliator
Body Moisturiser
Botox
Peels
Injectables / Fillers
None Of The Above
Client Expectations and Code of Conduct
To maintain a respectful and safe environment, we ask all clients to adhere to the following code of conduct:
Respectful Behaviour:
I agree to treat all spa staff and other clients with respect and courtesy. Inappropriate, insulting, or sexually explicit comments or behaviour will not be tolerated. I understand that any inappropriate behaviour may result in the immediate termination of my session and future services at this spa.
Confidentiality:
I understand that my personal information and treatment details are confidential and will be handled in accordance with the General Data Protection Regulation (GDPR).
Health and Safety:
I have disclosed any relevant health conditions or allergies. I will follow all safety instructions provided by the spa staff.
Appointment Etiquette:
I agree to arrive on time for my appointments. If I need to cancel or reschedule, I will notify the spa at least 24 hours in advance.
Consent to Treatment
By signing below, I acknowledge that: I have provided accurate health information. I understand the nature of the treatments I will receive and have had the opportunity to ask questions. I release The Ice House Hotel Chill Spa and its staff from any liability for any injury or harm that may result from my failure to disclose relevant health information or follow spa policies.
Agreement
Agreement
*
I have read, understood, and agree to abide by the code of conduct outlined in this consent form. I understand that failure to adhere to these expectations may result in the termination of my session and potential future services at Chill Spa.
Agreement
*
I agree to treat all spa staff and other clients with respect and courtesy.
Agreement
*
Inappropriate, insulting, or sexually explicit comments or behaviour will not be tolerated.
Agreement
*
I understand that any inappropriate behaviour may result in the immediate termination of my session and future services at this spa.
I wish to receive information on Chill Spa news, events & offers.
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