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Dear Guest,

Consultation Form

Spa considers your health, safety and comfort of the utmost importance. In order to make your visit to our spa a memorable and increase your comfort and pleasure please kindly answer the following questions:

1.

Have you undergone any medical operation during the past year? If yes, please provide a brief history

Yes

No

In case of a recent operation, has your medical doctor certified that it is safe for you to

undergo spa treatments?

Yes

No

2.

Do you suffer from any health condition such as high blood pressure, heart problems

or other illnesses?

Yes

No

If yes, please describe the nature of your illness

 

In any of the above cases, has your medical doctor certified that it is safe for you to

undergo spa treatments?

Yes

No

3.

Do you suffer from any allergy or skin sensitivity?

Yes

No

If yes, please state the type of products/ingredients you are allergic to

Dara Pirom Spa utilizes only the best quality spa products usually made from natural ingredients. We will strive to avoid using products with ingredients that you are allergic to.

4.

Question applies to Female guests only

 

Are you pregnant?

Yes

No

If yes, please indicate the stage of pregnancy Please note that it is not advisable for pregnant guests to have Spa treatments with the exception of selected beauty treatments such as manicure, pedicure, hair treatment and facials.

5.

Dara Pirom Spa recommends that you place your valuables in your room safe as we decline any responsibility for these items.

6.

Most of our treatments are best enjoyed without clothing, however if you prefer not to, kindly request for disposable undergarments from the spa therapist.

Disclaimer:

Spa is in compliance with all pertinent government regulations of the Kingdom of Thailand and acts in good faith. The customer accepts full responsibility for their visit to

Spa and waives all legal responsibilities of representatives.

Spa, its owners, staff and

Date:

Guest signature: