Swan Cove Spa & Salon Consultation

Name *
Name
Address *
Address
Phone *
Phone
Spa Client Profile Facial Analysis
Skin Type *
Select all that apply
If yes, please list the dates you received the treatments.
Do you have any of the following conditions? If yes, please explain as clearly as possible. *
Spa Client Profile Massage Analysis
Have you ever been diagnosed with any of the following skin disorders?
Examples: Cosmetic ingredients, food, iodine, medications, hay fever, latex
For Women Only:
*Swan Cove Spa & Salon does not sell, share or distribute any confidential information provided herein. I understand that the massage I receive is provided for the basic purpose of relaxation and relief of muscular tensions. If I experience any pain or discomfort during the sessions, I will immediately inform the therapist so that the pressure and or/strokes may be adjusted to my level of comfort. I further understand that massage should not be construed as a substitute for medical examination, diagnosis or treatment. I understand that massage therapists are not qualified to perform spinal or skeletal adjustments, diagnosis, prescribe, or treat any physical or mental illness, and that nothing said in the course of the sessions given should be construed as such. Because massage should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the message therapist updated as to any changes in my medical profile during the session and understand that there shall be no liability on the massage therapists part should I fail to do so. I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session. I also undersand that the License Massage Therapist reserves the right to perform massage on anyone whom he/she deem to have a condition for which massage is contraindicated.
First Name, Last Name