CLIENT HEALTH HISTORY

HEALTH QUESTIONNAIRE

Confidential Client Intake Form
Thank you for choosing Santi Massage & Spa. To ensure your safety and well-being, please complete this health questionnaire before receiving any Santi Massage & Spa services. Your information will be kept confidential.

Customer Information:

*Phone number:
*Birth Date:

Address:



Service Selection


Medical History

*Please check (✔) if you have or have had any of the following conditions

Lifestyle & Contraindications


Complete only if you receive massage therapy.

CLIENT CONSENT & WAIVER

I confirm that the above information is accurate and complete to the best of my knowledge. I acknowledge that spa treatments involve heat, steam, and water therapies, which may not be suitable for everyone. I accept full responsibility for my participation and release the spa and its staff from any liability for any adverse reactions. I understand that it is my responsibility to consult a physician if I have any concerns about my health before using spa services.

Thank you for taking the time to complete this form. We look forward to providing you with a relaxing and enjoyable spa experience!
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