Sinzinani Spa Client Card
Website
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 hereby warrant that I am physically and medically fit to proceed with the routine of treatments offered at Sinzinani Spa, which I hereby voluntarily undertake. I have read and understand the form and have answered the questions to the best of my ability. I hereby indemnify Sinzinani Spa, it’s management, staff, employees and assistants against any claim which may arise from any injury, loss or damage to either my person or property from whatever arising.
Yes, I would like to receive promotions and special offers from Sinzinani Spa.
SECTION 5 – SIGNATURE
Digital Signature (Type Full Name) *
Submit Client Card
