Dawson Manor Spa - Spa Services Form
Please complete the following profile at least 48 hours prior to your arrival.
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Email *
Name *
Full Address *
Contact Phone Number *
Date of Birth *
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Date of Appointment *
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Respiratory
Cardiovascular
Skin
Other Conditions
Head/Neck
Infections
Pregnancy
What is your general health condition?
Please list any Allergies
Current Medications, Condition it Treats and Known Side Effects
Surgery, Date, Nature:
Present involvement in any other health care, please specify:
Other Medical Conditions not listed above (e.g. digestive conditions, hemophilia, etc.):
Of Special Note (e.g. presence of internal pins, wires, artificial joints, special equipment):
Cancellation policy: We require a minimum of 48 hours notice for any cancellation or change in your appointment reservation. Because we block out time for a room and a service provider from our schedule for your appointment, 50% to a possible full payment will be deducted from gift cards or your pre-authorized credit card on file if we are not given the required notice for any changes to your appointment reservation. We reserve the right to apply a full-service fee for no-shows/same day cancellations. Late arrivals may require us to shorten the service time if possible, with full-service charge. If you arrive too late to begin and complete any of the service(s) in the time that was booked we will charge you for the full appointment. I acknowledge and understand the cancellation policy as listed above. *
Please type your first and last name below
I confirm to the best of my knowledge, that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. *
Required
If your health status changes in the future please let us know. All information gathered for the treatment is confidential except as required by law or to facilitate assessment or treatment. Your written authorization is required prior to the release of any information. Please check for confirmation that you have successfully submitted the form.
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