Sinzinani Spa Client Card
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SECTION 1 – CLIENT DETAILS
Full Name *
Contact Number *
Email Address *
Date of Birth *
SECTION 2 – MEDICAL INFORMATION
Please select any of the following that apply to you.
Pregnancy
Heart Condition
Cancer
Diabetes
High / Low Blood Pressure
Epilepsy
Recent Surgery
Skin Infection
Allergies
Thyroid Disorder
Varicose Veins
On Medication
Blood Thinners
SECTION 3 – ALLERGIES / MEDICATION DETAILS
Please list any allergies, medications, or relevant medical information
SECTION 4 – CONSENT
I confirm that I have disclosed all relevant medical information to the best of my knowledge and consent to treatment at Sinzinani Spa.
SECTION 5 – SIGNATURE
Digital Signature (Type Full Name) *
Submit Client Card
