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Client Intake & Consent Form: Japanese Head Spa

Please complete this form before your appointment. All information is strictly confidential and helps me provide the safest, most personalized experience for you.

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Client Information

Full Name ^*

Phone ^*

Email ^*

Emergency Contact — Name & Phone ^*

Date of Visit ^*

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Preferences & Customization

Preferred pressure during scalp massage: ^*

Light

Medium

Firm

Would you like a quiet, meditative session or relaxed conversation?

Quiet

Light conversation

No preference

Any other requests, preferences, or concerns?

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Client Intake & Consent Form: Japanese Head Spa

Health & Lifestyle

Hair & Scalp Care

Preferences & Customization

Consent & Acknowledgment

Thank you! 🙌