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Name:
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Email
*
Phone
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Your wellness choice
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Blue Daze Wellness foot reflexology 30 Min ($60)
Lavender Wellness hand & foot reflexology & stretching 30 min ($70)
Blue Salvia Wellness weightless pool massage 20 Min ($60)
Blazing Star Chair massage 30 Min ($60)
Coral honey suckle full body cabana massage 60 Min ($130)
Elliott`s Aster in room table massage 60 Min ($150)
Are you taking any Medication?
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0/500 characters
Please check all that apply
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Allergies
Contagious skin condition
Bruise easily
Varicose veins
Migraines
Heart condition
High blood pressure
Diabetes
Arthritis
Back pain
Epilepsy or seizures
Back or neck problems
Bone or Joint issues
Current fever
Smoke
Cancer
Recent surgeries
Current pregnant
None
What type of product application do you prefer
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Regular Lotion
Sunscreen SPF 15
Sunscreen SPF 30
Sunscreen SPF 50
Sunscreen SPF 70
Aloe Vera gel
Client signature
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Therapist Signature
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Therapist Name ( Print )
*
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