NEW GUEST QUESTIONNAIRE
Welcome to Vis-a-Vis! We’re completely dedicated to ensuring you have the most fantastic experience possible at our spa. In order to do this, we need to learn a bit more about you! From general contact info to allergies and lifestyle tidbits, the answers you provide to all of the questions below are completely confidential and will only be viewed by authorized Vis-a-Vis employees. Your practitioner may contact you after your visit to check in on your results and satisfaction. Your practitioner may make home care recommendations including stretching suggestions, and products to improve the look and feel of your skin/body/hair. Thank you so much for taking the time to carefully fill out this form. We appreciate you!
What’s your preferred method of communication with Vis-a-Vis? Phone Email Text
Were you referred to Vis-a-Vis by a friend?
(If referred by a friend, include their first and last name and they’ll receive points!)
How often do you visit a spa?
Be gentle, this is my first time I’m an occasional spa-goer I’m a seasoned professional!
Have you had chemical peels, laser, or microdermabrasion within the past 30 days? Yes No
Have you had Collagen, Botox, and/or fillers injected? Yes No If so, when?:
Do you participate in vigorous activities? Yes No If so, what type?:
What is your occupation?
Do you use a tanning bed? Yes No If so, when?:
Do you have any of the following conditions and/or health concerns, past or present? (Check all that apply):
Additional health-related comments/concerns:
In the event of a medical emergency, who should we contact?
Name: Phone: Relationship:
I understand, have read, and completed this questionnaire truthfully. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation from the services received. I am aware that it is my responsibility to inform the practitioner of my current medical or health conditions and update this history. The services I receive at Vis-a-Vis are voluntary and I release this institution from liability and assume full responsibility thereof.