MEDICAL QUESTIONNAIRE

Do you have any of the following?

No Yes

Allergies

Skin Conditions

Surgeries past 6 months

Recently broken bones

Pregnancy

Heart diseases

Any other medical conditions
7 Bali Spa should be aware of

I am aware of the side effects and risks of SPA treatments including massage and Hammam, with the condition(s) indicated in the consultation form. I have not been advised against having spa treatments by my medical advisor. I request to be serviced by 7 Bali Spa Ltd and take full responsibility for any consequences, and have no complaints to 7 Bali Spa Ltd.

MEDICAL QUESTIONNAIRE

Signature

Спасибо!

Спасибо!