The Leela Spa Consultation Form

Address:

Are you staying with us?

Yes No

Do you suffer from any of the following medical conditions?

If yes, please give details

Are you going through any of the following?

If yes, please give details

Medical History? (If yes, please detail):

Skin Type and Concerns:

Other

Massage Pressure:

Light Medium Firm Deep

Any part of the body you would like us to focus on or avoid?

CONSENT AND AGREEMENT

I hereby certify that the above statements are true and correct therefore I give my consent and authorization for my treatment to be carried out. I hereby consent to the use of my personal data (including any sensitive personal data) for the purpose of my treatment and any future treatment and confirm that any treatment is at my own risk without limiting or affecting any statutory rights I may have. I agree that any dispute or claim that arises out of or is related to such treatment and/or spa services shall be subject to the law and the exclusive jurisdiction of the courts of the country/region in which the relevant treatment/service took place. Personal data will be held by the spa, salon or store providing the treatment.