Consultation Form
Mingala Day Spa
Email address *
Full Name *
Mobile Number *
Use format 0871234567
DOB
1. Mobile device: Open the calender; Select the year "2020" on the top left to change to your relevant year. 2. Desktop: type in the date.
MM
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DD
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YYYY
What treatment are you having? *
List the treatments you will be having in your next appointment
Have you had a patch test? *
Some treatments may require a patch test prior to your appointment. If you are unsure please contact us.
Do you or have you had any of the following symptoms in the past 14 days? *
Select the box beside any symptom that you currently have or have had in the last 14 days
Required
Have you been in close contact with anyone in the last 14 days who has been tested positive with COVID19 or has had COVID19 symptoms? *
All clients are requested to wear a face covering to their appointment. Will you be wearing a face covering on your next visit to us? *
Do you suffer from any of the following medical conditions?
Select any of the below conditions that are relevant to you
Are you Pregnant?
Clear selection
If "Yes", how many weeks are you pregnant?
Are you currently taking any medication or under any medical supervision?
Clear selection
If "Yes", please give details:
Have you had any recent surgery, accidents or injuries?
Clear selection
If "Yes", please give details:
Skin Type and Concerns:
What is you’re current skincare routine?
Body Concerns:
Do you have any other issues that your therapist should know before starting your treatment?
I confirm that if I am in any doubt about my health I will obtain a medical clearance cert before having any treatment in Mingala Day Spa. *
Required
I agree to be contacted using the above details in relation to my appointments in Mingala Day Spa. *
I have read Mingala Day Spa’s privacy policy, available on their website, and I give my consent for my personal data to be used in accordance with this policy. Mingala Day Spa will only use your medical data as part of a pre-treatment screening. Your data is stored securely with password protection. I confirm that I have read the COVID19 Customer Notice available on our website. Mingala Day Spa reserves the right to refuse to do any treatment if we deem that you are not suitable to any treatment due to your personal contra indications or previous experience. By confirming below you release Mingala Day Spa of all liability for any injury or infection occurring while in the salon. *
Required
Water will not be provided in the salon. If you feel you may need water before or after your treatment please bring your own small bottle with you. Bringing water is recommended for massage or other spa treatments.
Important information:
Clients visit Mingala Day Spa at their own risk. Mingala Day Spa does not accept any liability in relation to the transmission of infectious diseases either on or off the business premises. By confirming and attending for your appointment you release Mingala Day Spa of any liability relating to the transmission of infectious diseases including COVID19. Please be confident that Mingala Day Spa has taken prudent steps to minimise the risks of COVID19 in as much as is reasonably practical.
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