2015-16 Complete Fitness & Spa Program

Thank you for taking the time to complete this Spa Treatment Preference Guide. Your responses to these questions will help us to serve you better. M EMBER N AME :

M EMBER N UMBER :

G UEST N AME :

D ATE :

M ASSAGE / B ODY S CRUB T HERAPY P REFERENCES Please indicate your areas of concerns. Please check all that apply:  Stress Reduction  Anxiety, Irritability, Fatigue, Insomnia  Headaches  Muscle Aches & Pains  Neck, Shoulder, or Back Pain  Injuries Are you sensitive to touch or pressure? Yes No

What pressure do you prefer? Light Medium

Heavy

How often do you receive massages?

Do you have a specific area you want focused on?

Do you suffer from arthritis or any vein issues?

Yes No

Do you have any allergies?

Yes No

Do you have any rashes or bruise easily?

Yes No

Are you pregnant?

Yes No

N AIL T HERAPY P REFERENCES Please indicate your areas of concerns. Please check all that apply:  Dry skin, thin skin  Nail Conditions  Rough, calloused or peeling skin on the feet Are you sensitive to touch or pressure? Yes No

What pressure do you prefer? Light Medium

Heavy

How often do you receive Manicures?

Pedicures?

Do you have diabetes?

Yes No

Do you have any nail or toe nail infections?

Yes No