Consultation Form — Preview

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Your personal consultation form

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For J*****
Booking · Brackenfell · Sat 3 Oct, 11:00

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🔒 Personal link CFL-2609-8QX2 · opened on device 1 of 2 · submits to client BC-0007 only · one submission

Prefer paper? Printable A4 forms: Massage · Facial & beauty

1Your visit

Branch

Plattekloof Brackenfell

Treatment(s) you are booking — choose all that apply

Filled in from your booking when you open the link we send you.

2Personal details

Full namerequired Date of birth (dd / mm / yyyy)required

Gender optional

Female Male Other Prefer not to say

Mobile number (with country code)required

Email address Address Emergency contact

3Health & medical history

Is this your first visit to Oriental Spa? YesNo

Do you have, or have you had, any of the following? Tick all that apply.

You ticked something above — please give us any further details

4Medication

Are you currently taking any medication? NoYes

Have you taken any painkillers or medication today? NoYes

6aBeauty treatment preferences

What would you like today? (tick all that apply)

7Body concerns

8Massage preferences

What type of massage would you prefer today? You can choose more than one.

Pressure you prefer

LightGentle, relaxing touch MediumBalanced pressure FirmDeeper, for tension relief DeepStronger, for muscle knots

9Focus areas

Anywhere we should avoid?

10What would you like to achieve today?

From your massage

From your facial or beauty treatment

11Waxing

Using Roaccutane, retinol or prescription creams on the area? NoYes

Sunburn, laser or a peel on the area in the past 2 weeks? NoYes

12Nails

Any nail or foot infections, including fungal infections? NoYes

Any cuts, sores or ingrown nails? NoYes

13Consent & agreement

I have provided accurate information about my health, medical history and preferences. I understand that it is my responsibility to inform my therapist of any changes to my health, medical history or skin condition. I give my consent for the treatment(s) to be carried out by the therapist at Oriental Spa.required I understand the treatment may be adjusted or declined if it is not safe for me, and that spa treatments are for relaxation and wellbeing — not a substitute for medical care.required My health information: I consent to Oriental Spa keeping the health information on this form so therapists at both branches can treat me safely.required Offers and news by email or WhatsApp.optional — you can say no and still be treated

Your privacy. Oriental Spa (Pty) Ltd collects this information to treat you safely. Only our reception team and therapists can see it, through our secure booking system, and every time someone opens your record it is logged. We do not sell or share it. We keep it for five years after your last visit, then delete it. You can ask to see or correct it at any time: [email protected]. Should you wish to have your records deleted, please contact Oriental Spa Management: Jasmin Tshangana at [email protected].

14Signature

Client signature — draw with your finger or mouserequired

Sign here

Full name (typed)required

Date

You are under 18, so a parent or guardian must complete this form with you.

Parent / guardian namerequired

Relationship

The therapist signs in the spa when your treatment starts.

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In the live form the client sees “Thank you — your form is with our reception team.” This is what reception would receive:

Client Consultation Form

Your personal consultation form

1Your visit

2Personal details

3Health & medical history

4Medication

5Lifestyle & wellness

6Skin analysis & concerns

6aBeauty treatment preferences

7Body concerns

8Massage preferences

9Focus areas

10What would you like to achieve today?

11Waxing

12Nails

13Consent & agreement

14Signature

Preview only — nothing was sent