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(615) 721-7830
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Spa Intake Form
Thank you for completing the intake form.
Guest Information
Full Name
Date of Birth
Phone Number
Email Address
Preferred Method of Contact
Phone
Email
Shoe Size
Robe Size
Tell Us a Little About Yourself
Holistic Intake
Body Inventory
What do you do to maintain your sense of health & balance?
How do you nourish yourself with food?
Is your sleeping environment nourishing to you? What is your sleep routine?
What exercise or movement practices help you to feel embodied?
Mind Inventory
What practices do you have to calm your mind and manage your stress?
Do you have a creative outlet? If yes, please describe.
What are your emotional strengths and challenges?
How do you relate with your unconscious mind? (i.e. dreams)
Soul Inventory
How do you express gratitude?
Do you consider yourself a spiritual person?
What is your relationship with nature and the elements?
Treatment Preferences & Customization
What is your primary intention presently?
Relaxation
Pain Relief
Emotional Reset
Celebration
Preferred treatment modalities
Massage
Facial
Body Treatment
Energy Healing
Do you prefer a male or female provider?
Male
Female
No Preference
Preferred room temperature
Cool
Comfortable
Warm
Conversation preference during treatment
Quiet
Open to light conversation
Provider's discretion
Areas of focus or concern (e.g., physically or emotionally)
Health & Wellness Information
Do you have any allergies (essential oils, nuts, latex, etc.)?
Are you currently
Pregnant (1st Trimester)
Pregnant (2nd Trimester)
Pregnant (3rd Trimester)
Nursing
Recovering from recent surgery
Any medical conditions or injuries we should be aware of?
Are you under the care of a physician or currently taking medications that may affect your treatment?
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