Name *

First Name

Last Name

Phone *

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Address

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Address 2

City

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Date of Birth

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Spa Policy Acknowledgement *

I have read and agree to the Terms and Conditions of Spa 180's Policies.

Name *

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Reason for scheduling a massage today: *

Relaxation

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Received a Gift Card

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Health Conditions *

Please check all that apply.

Osteoarthritis

Rheumatoid Arthritis

High Blood Pressure

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Cancer

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None of the above

Policy Acknowledgement *

I have read and agree to Spa One Eighty's Policies.

I agree

Date *

MM

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