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The last night of a two week stay on the North Shore of Oahu, Hawaii._edited.jpg

TOUCH OF PARADISE

MASSAGE & FACIAL SPECIALISTS IN WEST EWELL

TREATMENT EVIDENCE FORM

Welcome to Touch of Paradise, we hope you enjoy your treatments with us today.

Please fill in the form below before we get started.

Please note you will receive 1 follow up email from us after your appointment.

Your Full Name

Your Email Address

Your Phone Number

Are you happy to receive updates and offers? * Required

Email

SMS

No Marketing

Do you have any of the following? * Required

None of the below

Back Problems

Circulatory disorders

Diabetes

Epilepsy

Food Allergies

High Blood Pressure

Low Blood Pressure

Skeletal Problems

Skin conditions

Thrombosis/Varicose Veins

Thyroid conditions

Other

Are you pregnant or trying to get pregnant? * Required

Yes

No or N/A

Are you taking any medication/under medical supervision?

Have you had any recent operations or accidents? * Required

Yes

No

Do you have a disability? (Please tick if applicable)

Physical impairment

Hearing impairment

Visual Impairment

Learning disability

Multiple impairments

Health/other impairment

TREATMENT EVIDENCE FORM SUBMITTED

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TOUCH OF PARADISE

Massage & Facial Specialists in West Ewell - KT19 9UH.

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