Healthy Consultation – Saengsiri Mallorca

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Health Consultation
SAENGSIRI
THAI SPA
Dear Guest,
SAENGSIRI Spa considers your health, safety and comfort of the utmost importance. In order to make you visit to our spa a memorable and increase your comfort and pleasure. Please kindly answer the following question:
Name
Date of Birth
Address
Nationality
Email
Phone
Treatment
Time
Do you have any particular areas you would like us to focus on today?
Are there any areas on your body that you prefer to NOT be touch/massage?
Have you ever had an injury or operation? If yes, what kind?
Do you suffer from any allergies or skin conditions?
Are you currently taking any medication?
Are you sensitive to fragrances or perfumes? If yes, what kind?
Health check, please tick if it´s necessary:
- Cancer
- Varicose Veins
- Cuts / Bruises
- Edema
- Pregnacy
- Epilepsy
- Fever
- Sprains
- Lymphatic Problems
- Blood Clotting
- Migraine / Headache
- Neuropathy
- Jomt Replacement
- Heart Problems
- Inflamed Nerve
- Muscle Tension
- Diabetes
- Thyroid
- Sunburn
- Bone Fracture
- Blood Pressure
- Metal pm/ Plates
- Localised Sweling
- Other
Is there anything else that may be important for us to know?
Guest Signature:Therapist Signature:
Date
Date Format: MM slash DD slash YYYY

Health Consultation