Couples Massage Intake Form

Sunrise Spa
Couples Massage Intake Form

Complete intake forms for both clients

If you are visiting first time, please complete General Intake Form

If you prefer offline, please download: Massage Intake Form PDF

Request Details

Client 1 Info

Client 2 Info

📅 Request Details - For Both Clients

*Appointment Date

*Time Slot

*Selected Massage

👤 CLIENT 1 INFORMATION

*First Name

Middle

*Last Name

*Phone

*Email

* Any allergies? (oils, lotions, nuts, fruits, skin, etc.)

Yes

If yes, please List it :

*Are you pregnant?

Yes

N/A

months? Due Date:

*Areas of broken skin? (e.g., rash, wounds)

Yes

If yes, where?

Please describe any injuries or health conditions:

*Reason for seeking massage:

Relaxation

Specific problem

Please list and describe any areas of discomfort:

By signing below, I acknowledge that I am aware of the benefits and risks of massage therapy and that I have completed this form to the best of my knowledge. I also agree to inform my massage therapist of any health or medical changes. When called by Sunrise Spa after submission of this form, I agree to provide my credit card information to book the exact appointment time.

*First Name

*Last Name

*Signature

*Submission Date

👤 CLIENT 2 INFORMATION

*First Name

Middle

*Last Name

*Phone

*Email

* Any allergies? (oils, lotions, nuts, fruits, skin, etc.)

Yes

If yes, please List it :

*Are you pregnant?

Yes

N/A

months? Due Date:

*Areas of broken skin? (e.g., rash, wounds)

Yes

If yes, where?

Please describe any injuries or health conditions:

*Reason for seeking massage:

Relaxation

Specific problem

Please list and describe any areas of discomfort:

*First Name

*Last Name

*Signature

*Submission Date

Sunrise Spa - Formerly Paradise Spa

Sunrise Spa Couples Massage Intake Form

Complete intake forms for both clients

If you are visiting first time, please complete General Intake Form

If you prefer offline, please download: Massage Intake Form PDF

Request Submitted!

📋 Next Steps

Sunrise Spa
Couples Massage Intake Form