Consultation card form

Consultation Card

Welcome to Proud Thai Spa.

Please kindly complete this consultation card. We will review it with you to ensure that we understand your expectations and make suitable recommendations for you.

Thank you

First Name

Last Name

Date of birth

Contact Number

Address Line 1

Address Line 2

City

Postcode

Medical Information

Please let us know if you have any health conditions that mayaffect your treatment, including any from the list below

Please specific your alergies

Please specific if you selected Other

STATEMENT AND DISCLAIMER

I, undersigned, fully understand that any spa treatment I receive is at my own risk and is not only for the purpose of relaxation and stress reduction, not for the purpose of medical treatment. I understand that information provided by me is used only as a guideline for my treatment and I will inform the therapist to adjust my comfort level if anything is not suitable. I am aware that it is advisable to have a medical assessment and to seek my doctor's advice before commencing the treatment, and recognise the need for regular medical discharge Proud Thai Spa form all liability, claim, loss, damage, injury, illness or adverse effects relating directly from any use of massage treatment.

Guest signature

Signed date