If you have scheduled an appointment & it is your first visit with us,

Please fill out our Client Intake Form .

Please note: Form has not been submitted unless you see

"Thank you for submitting."

Client Intake Form

First Name

Phone

Last Name

Street Address

City/State

Zip Code

Emergency Contact (Name & Phone)

Occupation

Birthday

Height & Weight

Referred By

List any medications or supplements you are currently taking (including aspirin):

List any accidents, surgeries or major illnesses, date & description:

List all allergies:

Are you currently pregnant?

If yes, when is your due date?

Other:

Please explain any symptoms or conditions you checked:

I affirm the information I have provided on this form is true and accurate, to the best of my knowledge. I agree to inform Ahh Spa of any changes in my health status at successive appointments before receiving any further treatments. I understand that therapists and estheticians do not diagnose illness, disease, or any other physical or mental disorder. I am aware that information exchanged during any session is educational in nature and is not intended as medical advice. All information given on this form is confidential.

I agree to the terms & conditions

Thank You For Submitting!