Spa Treatment Discharge Form
Please complete this form to confirm your safe discharge and understanding of post-treatment care after your spa session.
Client Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Date and Time of Discharge
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Treatment Received
*
Please Select
Massage Therapy
Facial Treatment
Body Scrub/Wrap
Sauna/Steam Room
Hydrotherapy
Other
Name of Attending Staff
*
Have you experienced any of the following after your treatment? (Select all that apply)
*
Dizziness or lightheadedness
Nausea
Allergic reaction (rash, itching, swelling)
Muscle soreness
None of the above
Other
Post-Treatment Instructions Provided
*
Hydrate with water
Rest as needed
Avoid strenuous activities for 24 hours
Follow specific skincare/body care advice
Other
Additional Comments or Concerns
Please sign below to acknowledge your discharge and understanding of aftercare instructions.
*
Submit Discharge Form
Submit Discharge Form
Should be Empty: