Spa Consultation Title: —Please choose an option—MissMrsMr Confidential Lifestyle Consultation Skin Type & Concerns (please tick) NormalDryCombinationOilyAcneSensitiveExtra SensitiveSun DamageLines/WrinklesHigh ColourPigmentationDark Circles/PuffinessTired & FatiguedLack of elasticityIrritated How would you like your facial skin feel? SmoothFirmVitalHydratedNourishedRelaxedClear Lifestyle: What's your quality of sleep? DeepLightDisturbed What's your current status? WorkingHome-basedRetired What hours do you work? Part-timeShift-workFull-timeHome-based How do you travel to work? WalkPublic TransportCar How offten do you exercice? NeverDailyWeekly Do you smoke? No1-20 per day20+ Do you wear contact lenses? YesNo Body Skin Type & Concerns (please tick) Dry SkinCelluliteOverweightVaricose VeinsPoor CirculationAches/PainSensitiveSensitive against pressureIrritatedWithout vitalityWater retention How would your body skin to feel? SmoothFirmVitalizedHydratedNourishedRelaxedRelieved Do you suffer from any of the following medical conditions? AllergiesBack ProblemsHeart ConditionsHigh/Low Blood PressureEczemaCancerIrritable bowel syndromeArthritisClaustrophobiaRheumatismHyperthyroidConstipationIodine (Seaweed) AllergyAsthmaEpilepsyPsoriasis Are you going through any of the following?DepressionPregnancyMenopauseBreast FeedingPre-Menstrual TensionHeadaches/Migraines Medical History (If yes, please detail): Are you on any medication or under medical supervision? YesNo Is there a history of any family illnesses? YesNo Have you had recent surgery, accidents or injuries? YesNo Massage Information Have you had a professional massage before? YesNo What type of massage are you seeking?RelaxationTherapeutic/Deep TissueOther What pressure do you prefer? LightMediumDeep Are there any areas (feet, face, abdomen, etc) you don't want massaged? YesNo What the best describes how your muscles feel most of the time? TenseShortenedBalancedTiredStressedEnergized
