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Name
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Medical Information
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Please indicate if you are suffering from any of the following
Cancer
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If you answered yes to any of the above, please provide more detail
Are you Pregnant?
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If Yes, how many weeks?
Please note treatments are not suitable during the first trimester of pregnancy and some treatments are not suitable at all during pregnancy for example Hot Stone Massage
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If yes to any of the above did you consult a doctor or medical practitioner?
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Lifestyle
Daily consumption of plain water
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Sleep patterns
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Are you using products containing Retinol A or AHAs?
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Contact lenses
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Would you like to upgrade your experience by adding a Glass of Prosecco? Eur 11.50pp
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Would you like to upgrade your post-treatment experience by adding a Sensory Retreat Heated Eye Mask Eur 6.00pp
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Would you like to upgrade your experience by adding a Mocktail? Eur 5.00pp*
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I hereby certify that the enclosed is true and correct and that I use the facilities and services at my own risk and do not hold The Spa at The Kingsley or any of its employees responsible.
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