Oasis Massage and Spa- Package Intake Form
The following is for our records only. We will not sell or give out your information.
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Full Legal Name: *
Mobile Number: *
Email: *
Address (including zip code) : *
Date of Birth: *
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Emergency Contact Name and number: *
Occupation:
How would you like to receive appointment reminders? *
How did you hear about Oasis?
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Massage Section: Please mark all areas of pain.
Please mark any areas you would like avoided during your massage:
Mark all Health conditions:
If pregnant, how many weeks?
Skin Care Section: Please mark any that apply
What are you currently using to cleanse your face? *
What are you currently using to moisturize/protect?   *
Are you using any special treatments (eye cream, night cream, masks)?
What concerns do you have about your skin, and what improvements would you like to see? *
Statement of Understanding

I understand that massage therapy is for the well-being of the body and mind. Our licensed massage therapists do not diagnose illness, or any physical or mental disorder, nor do they prescribe any medical treatment. I understand that massage therapy is not intended for sexual purposes.  At any time throughout the massage if either I or my therapist should feel uncomfortable, the appointment can be immediately terminated.

Our licensed estheticians do not diagnose, nor do they prescribe any medical treatment. My esthetician may choose to use surface peeling products during my facial, and I give consent.  I will contact my esthetician with any concerns or questions.

To better the results of my services, I have fully completed the above information to the best of my knowledge. Also, as a client, my health information will be utilized only by my service providers. I acknowledge that Oasis Massage and Spa reserves the right to refuse service to any client for any reason; clients who appear to be under the influence of drugs and/or alcohol, will be turned away for their own safety and to protect the integrity of our service providers and their license.

Date acknowledging the Statement of Understanding: *
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