Client Intake Form

Personal Information

Please complete this form to help us provide safe and personalized care. All information is kept confidential.

First name*

Last name*

Phone*

Birthday

Month

Day

Year

Have you visited us before?*

Yes

Health History

Do you have any medical conditions or chronic issues we should be aware of? (e.g., high blood pressure, diabetes, back pain, etc.)*

Yes

Do you have any allergies or sensitivities (e.g., oils, scents, skin products)?*

Yes

Are you currently pregnant?*

Yes

Have you had any recent surgeries or injuries (within the last 6 months)?*

Yes

Additional Information

Are there any areas of the body you prefer not to be massaged?

Any specific requests, concerns, or goals for today’s session?

Consent & Acknowledgement

I confirm that the information provided is accurate and complete. I understand that the spa treatments are not a substitute for medical care and I consent to receive services at my own discretion.

Signature*

Signature field is empty.

NuchDesigns.com

66 Main St South Kingstown Ri 02879

401-284-6563

401-396-6990

salathairi@gmail.com

Open Monday-Saturday

Summer: 8.30-8.00

Last appointment at 7.00 pm
Except Thursday 9.00-8.00
Last appointment at 7.00 pm

Winter: 9.00-7.00

Last appointment at 6 pm.

We are closed on Sunday

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