Step 1 of 4 25% Welcome to Core Essence. This information will be used to enhance the quality of your experience and assist us in ensuring we provide the best possible treatment to meet your needs. The information below will be kept confidential and not shared with any other party.About YouTitle Name(Required) Full Name Address Suburb Phone(Required)Email(Required) Date of Birth MM slash DD slash YYYY Occupation Emergency Contact Name First Last Emergency Contact Phone General HealthPlease circle if any of the following currently applies to you. Thyroid High/Low blood pressure Diabetes Epilepsy Heart Condition Liver Condition/Kidney Condition Claustrophobia Haemophilia Digestive Constipation Varicose Veins Arthritis Sinus/Hay Fever Asthma Eczema/Psoriasis Oedema/Swelling Poor Circulation Cellulite Allergies Open Sores Ingrown Hairs Pins/Implants Menopausal Pregnancy Breast Feeding Hormonal Imbalance Cancer Headaches/Migraines Vision Problems Infectious Disease Other Are you taking any medication? If pregnant, how many weeks? Please specify any recent injuries or surgery (within the last 3 months)Have you experienced a treatment at a Day Spa before? Yes No BodyAre you experiencing any soreness/stiffness/joint pain Yes No Please specify the pain that you are experiencing? Please circle any areas you would like AVOIDED in your treatment Scalp Face Neck Back Legs Feet Massage Pressure Light Medium What areas of concern do you have regarding your skin?Have you had a reaction to any of the following? Skincare Cosmetics AHA’s Fragrances Sunscreen Food Please specify any reaction Have you recently had any of the following? Chemical Peel IPL Laser Microdermabrasion Injectables Needling LED Light Therapy Skin Flaky Excess oil Shine Dull Dry Wrinkles Fine Lines Redness Skin Breakouts Blackheads Pigmentation Uneven Skintone Dehydration Eyes Wrinkles Puffiness Dark Circles Flakey Dehydrated Lips Surrounding Lines Cracked Chapped What skin care routine do you follow? Soap Cleanse Toner Neck Cream Sunscreen Exfoliant Eye Cream Serum Moisturiser Mask How did you find out about Core Essence Day Spa? Goals and ExpectationsWhat would you like to achieve from today's visit?During your spa treatment, what do you ENJOY the most?During your spa treatment, what do you enjoy the least?As we are a bespoke day spa, we wish to ensure that your spa treatment is the most enjoyable self-care experience for YOU!Consent Policy(Required) I agree to the CORE ESSENCE policy.I agree to being kept up to date on the latest CORE ESSENCE product offers, benefits and services. CORE ESSENCE would like to access the information you provide to send you the latest CORE ESSENCE product offers, benefits and services. I confirm to the best of my knowledge that the answers I have given are correct and that I have not withheld any relevant information. I am aware that wet areas may be slippery and that I will take care in those areas not to slip and fall. I acknowledge that I am personally liable and do not hold CORE ESSENCE liable for any consequences that may occur should I slip or fall, from not following any instructions or for any problems caused by not disclosing any relevant health or medical conditions.