Confidential Client Consultation form

New ‘Crown Clarity‘ treatment

I am delighted to introduce Indian Head Massage at Lynne’s Zen Room, a deeply relaxing treatment designed to restore balance, calm the mind, and ease tension held in the upper body.

SPECIAL INTRODUCTORY OFFER- £25

(normally £35, limited time offer)

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Your name

Address:

Telephone:

Date of birth:

Occupation:

Doctor’s name and address:

Have you had any surgeries recently?

Do you have any known medical conditions?

Are you taking any medication?

Do you have any allergies?

Are you pregnant?

To make your session as comfortable and relaxing as possible, please let me know if you have any preferences or dislikes for sounds and aromas: e.g., nature sounds, lavender, etc

Please add any additional information you would like to add:

Any details and information that you provide are kept private and confidential; only I have access to them, and they are only used for the purpose of providing the best experience for you