SPA HEALTH QUESTIONAIRE 2018

Strictly Confidential – please print clearly
To provide you with any Spa Treatment from our experienced therapists, we require you complete this form which will alert us to any allergies, illness, physical disability or mental conditions that we should know about. This will assist us in providing you with a treatment without causing any aggravation to pre-existing ailments. Thank you.
*To respect other guests enjoying the tranquillity of the Spa, please turn OFF your mobile phone and converse quietly throughout the Spa.
**Please note underwear must be worn during all spa treatments. Please ask your therapist if you require a disposable pair. Swim wear must be worn while in The Mineral Spa, Roman Bath and Steam Room facilities. Thank you
**If you are having a facial please also complete the back of form**
Thank you! This confidential information is to ensure you receive the most appropriate care and attention.
FACIAL ANALYSIS:

We use Pevonia Botanica & Mukti products in our facials. These products contain botanical ingredients & natural oils. A full list of ingredients is available upon request if required. Please advise your therapist if you have any skin allergies, sensitivity or have experienced skin reactions in the past.
For the most personalised and appropriate facial treatment, please provide as much information as possible:
4. Have you recently received any of the following spa services?
6. Do you suffer from any allergies or have had skin reactions in the past? (ie. cosmetic ingredients, food/s, iodine, nuts, essential oils, latex etc.)
Thank you! This confidential information is to ensure you receive the most appropriate care and attention.
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