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Ionic Spa appointment
WITH APPOINTMENT ONLY
Detoxification and purification with the ionic spa helps to restore our vitality which is affected by the toxins we find in our environment.
Complete the * sections. The information collected in this form will be used to complete your client's file.
I'm a new client :
*
yes
no
(For new clients, there is a $10 file opening fee.)
First name
*
Last name
*
Email
*
Phone number
*
###
-
###
-
####
Address
*
Town / Village
*
Postal Code
*
Date of Birth :
DD
/
MM
/
YYYY
DD = day, MM = month, YYYY = year
Exemple : 24/02/1975
My choice is :
*
Ionic spa (15 min) with foot massage (30 min) / ($55)
Ionic spa (30 min) with foot massage (3o min) / ($80)
Ionic spa 15 min ($25)
Ionic spa 30 min ($40)
I have allergies and/or intolerances to essential oils, incense, perfume or other.
*
yes
no
other
If any, specify in Important note(s).
For my Ionic Spa appointment, I choose the following essential oil blend (in diffusion):
Balancing
Anchorage
Meditative
No Thanks! Not for me!
Important note(s) :
(pain, allergies, etc.)
Checkmark the moment to receive the massage.
morning
afternoon
evening
Checkmark your preferences.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
My method of paiment:
*
check
cash
credit card
Interac credit transfer
Apple Pay
Google Pay
For Interac credit transfer, use the following email: rohrei@yahoo.ca
Naturotherapy receipt
*
I need one. Thanks!
I don't need one.
Please use the following way to reach me :
*
Email
Phone
text message
Facebook
For texting, please provide me a mobile phone number that Iwill be able to use to confirmat your massage appointment.
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