Spa Intake Form

Kindly complete the appointment request form or spa party request form if you haven’t already, and be sure to confirm your appointment availability with us before filing this form.

First name

Last name

Phone

Address

Zip Code

Date of birth

Emergency Contact Name and Number

Do you have any known allergies? If so please indicate below

Do you have any chronic medical conditions that we should be aware of or do you take any medications?

Are you pregnant? If yes please indicate your due date

Have you had any recent surgeries or injuries?

Preferred Service

Massage

Facial

Full Service - Massage & Facial

Waxing

Our detailed booking policy & terms and conditions are available to the public.

Please read the terms and conditions and acknowledge that you have read and understand the terms and conditions prior to submitting this form.

Credit Card Number

Expiration Date

3 Digit CVV code (present on back of the card)

I read, agree, and understand the terms & conditions publicly listed on https://www.tranquiltownbankspa.com

Signature

Signature Date