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online Spa Consultation Form
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Name
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Medical Information
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Please indicate if you are suffering from any of the following
Cancer
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Recent Operation
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Product Allergies
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If you answered yes to any of the above, please provide more detail
Are you Pregnant?
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If Yes, how many weeks?
Please note treatments are not suitable during the first trimester of pregnancy and some treatments are not suitable at all during pregnancy for example Hot Stone Massage
Are you taking any medication or supplements?
If yes to any of the above did you consult a doctor or medical practitioner?
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Lifestyle
Daily consumption of plain water
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Are you using products containing Retinol A or AHAs?
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Contact lenses
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What is your required slipper size?
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I hereby certify that the enclosed is true and correct and that I use the facilities and services at my own risk and do not hold The Spa at The Kingsley or any of its employees responsible. I also understand that I am kindly requested to reschedule my appointment if I am experiencing any flu like or Covid-19 symptoms or if I have been in contact with anyone that has tested positive for Covid-19 in the last 14 days.
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