Kalma Spa - West Hampstead Spa & Massage

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Please fill in the consultation form after you have booked your appointment & please read our house rules below.

Please note:

The consultation form must be filled out by the person having the treatment

If the information provided is incomplete or unclear, you will have to refill the form again.

Client Consultation Form

First Name

Full Address

Date of Birth

How did you hear about us?

Last Name

Phone

Postcode

Occupation

Sex *

Male

Female

Prefer not to say

Medical History

Medical conditions? i.e diabetes, heart disease, cancer?

Collagen, restyle, botox injections?

Implants anywhere in the body?

Are you taking any medication?

Contagious skin disease?

Have you recently had surgery?

Metal pins/ Plates/ Heart Pacemaker or other?

Do you have any HIV/Aids/autoimmune disease?

Are you currently undergoing treatment for any illness/injury?

Have you recently used any form of skin peels?

Do you have any allergies?

Should we be aware of an other medical conditions?

Are you pregnant *

Yes

N/A

If you are pregnant, how many weeks are you? Please note: we cannot perform massage in the first trimester (only from 4 months onwards)

I can confirm, to the best of my knowledge, that the answers given are correct and that I have not withheld any information that may be relevant to my treatment.

I agree to notify Kalma Spa about any changes to my medical history everytime I have further treatment

Would you like us to email or text you regarding any special promotions that we run occasionally? *

Yes

We use Phorest software booking system that will email/text you a reminder of your appointment and keep you informed about your booking/s.

Please enter today's date as part of your consent of the above consultation form

Sign to confirm all details are true and all informationhas been disclosed.

Thanks for registering!

House Rules:

Please only book when you are absolutely sure you are able to make your appointment.
We have a strict 24 hour cancellation policy. Any cancellations made with less that 24 hours will be charged will be charged the full treatment price.
Treatment must be booked under the same name as the customer who will be receiving treatment.
No mobile phones to be used in the spa.
No food of drink allowed inside the practice, only water.
Any form of abuse will not be tolerated and will be reported to the police.