Spiritual Bath Intake Form
Blessings! Bendiciones! Thank you for taking the time and investment to care for the most important person in your life. YOU!
It is an honor to create a Spiritual Salt Bath for you!  Please complete the form as this information will guide me to prepare your personalized bath. Thank you for your trust & supporting a Latina owned business!  
With gratitude, Colectiva Wellness & Healing
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Email *
Name *
Mailing Address *
Phone Number
Are you sensitive or allergic to any herbs, flowers, fragrances or essential oils? *
Reason for Bath - What is calling you to receive this bath? How do you feel? Physically, Mentally, Emotionally and Spiritually? Feel free to get raw and deep on this question, this information will guide me in creating your bath!  *Please note all information is client confidential* *
Payment Options - Please select type of payment *
Required
Please provide your payment option username or email to send payment request.  I.e., Paypal, Venmo or Cashapp *
Would you like your bath shipped or drop off? *Drop off occurs weekly within Merrimack Valley area* *
Would you like to be included in Colectiva's bi-monthly e-newsletter starting in 2021?  This will include updates on offerings, services, upcoming events, classes & workshops! *
How did you hear about Colectiva Wellness & Healing? Who do I need to thank?!   *
A copy of your responses will be emailed to the address you provided.
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