New Client Intake Form

Please fill out this form before you arrive for your first visit at Zazen Salon Spa. It will be emailed to us and be kept on file. This allows us to serve you better and gives us consent to provide you with our fine services.

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Source
Name:*
Date:*
MM slash DD slash YYYY
Address:*
City State / Province / Region ZIP / Postal Code
D.O.B.*
Contact Phone:*
(to confirm apts.)
Email Address:*
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Date
MM slash DD slash YYYY
How did you hear about us?
Are you:
- Pregnant
- Have a pacemaker
- Heart condition
- Metal plates
- Prone to seizures
List the medications are you currently taking:
List any allergies or skin sensitivities that you have:
FACIALS/WAXING:
What is your major complaint or condition you want to improve?
Please describe your skin type (Ex: Oily, Dry, Sensitive):
Zazen does not refund cash for services or products. Also, please allow 24 hours to cancel/reschedule appointments or you may be subject to a cancellation fee. Zazen is a full service salon and spa using only quality professional products. Zazen is not responsible for reactions or other health issues arising from products and procedures used during treatment or aftercare. By typing your name in the Client Signature line, you acknowledge this information is accurate.
Client Signature:*
Date:*
MM slash DD slash YYYY
4 + 7 = (for authentication purposes)*
Please enter a number that represents 4 + 7

11 Bellwether Way Suite 102
Bellingham, WA 98225
(360) 715-1050
info@zazensalonspa.com

New Client Intake Form

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