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Appointment Details

Please confirm the details of your visit.

If any of these details are incorrect, please contact your therapist before completing the consultation.

Please tell us a little about yourself.

Full name Date of birth Email address Contact number Address

Is this your first scalp spa treatment?

__RADIO:firstTreatment:Yes|No__

Help us understand your hair, scalp and reasons for visiting.

Primary reason for your visit

__CHECK:reasons:Relaxation|Scalp Health|Hair Growth & Thickness|Reduce Hair Loss|Other__

Hair type

__RADIO:hairType:Straight|Wavy|Curly|Other__

Hair thickness

__RADIO:hairThickness:Fine|Medium|Thick / Coarse__

Hair length

__RADIO:hairLength:Short|Medium|Long__

Scalp concerns

Current hair concerns

These details help your therapist consider how your treatment can be tailored safely and comfortably.

Do you currently have, or have you recently experienced, any of the following?

Medical information noted — please discuss this with your therapist before treatment.

Additional medical information

Let us know what would make your experience most comfortable and beneficial.

Desired outcomes

Sensitivity level

__RADIO:sensitivity:Not Sensitive|Mildly Sensitive|Sensitive|Unsure__

Preferred massage pressure

__RADIO:pressure:Light|Medium|Firm|No Preference__

Additional notes or special requests

Please review your answers before continuing to your signature.

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Your consultation has been submitted successfully.
I look forward to welcoming you to Escape Head Spa.

Escape Head Spa

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