Client Check-In | The Busy Goddess Spa

Date

Date of Birth

Phone Number

Email

Who are you here to see?

Jessie Weigum

Glow by Jessie

Samantha Lawrence

Loosen Up Buttercup Massage

Norma Goodrich

Well Life Integrated Medical

Are you currently taking any prescription medications?

YesNo

Do you / have you used Retin-A, Renova, Adapalene, Accutane, Differin, Glycolic Acid, Lactic Acid, Mandelic Acid, Retinol, or other Vitamin A derivatives?

YesNo

Do you have any of the following symptoms?

Have you had close contact with a person diagnosed with COVID-19?

YesNo

Would you like to request a silent appointment today?

Yes, I'm here to relaxNo, I don't mind conversation

Optional Notes

Anything else you'd like your practitioner to know before your appointment?

Stay in the loop?

Sign up to receive exclusive discounts, promotions, and event invites from The Busy Goddess.

Yes, I'd love that!No thanks

I acknowledge that the information provided is accurate and I consent to receiving services at The Busy Goddess Spa. I understand the risks and benefits of the treatments I am receiving.

Signature

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