08 9331 1122
Cnr Gilbertson Rd/South St,
Kardinya, WA 6163
ABN 68 345 210 850
Email lebeaudayspa@bigpond.com.au

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Le Beau Bay Spa
Skin and Body Management

Here at Le Beau we strive to deliver service beyond expectations.So we can understand your individual needs, we appreciate you completing the information below.

Please tick if you do not wish to receive marketing literature

Name:

D.O.B:

Address :

Telephone:

Email:		Occupation:

Partners Name:		Your Anniversary:

Do you have children?

Client History:

Please tick where applicable to assist us with the correct treatment for you! All information is highly confidential.

Are you allergic to iodine?

Have you had collagen injections?

Are you pregnant/may be pregnant?

Have had chemical peels?

Have you recently had surgery?

Have had lipo suction?

Are you on any medication?

Have had IPL Treatments?

Are you on skin related medication?

Have had breast implants?

Do you have allergies?

Have had laser treatments?

Cancer or lymphatic?

Epilepsy / metal plates / pace maker?

What face products do you currently use?

What face products have you previously use?

What body products do you use?

Describe your main concerns (if any):

Skin:

Face:

Body:

What level of pressure would you prefer your message?	Soft	Medium	Firm

What level of conversation would you prefer during your treatment?	None	Informative	Social Talk

What has made you leave past salons?

How did you hear about Le Bleau?

What make a good day spa to you?

Service

Your Experience

Staff Knowledge

Facilities

Cleanliness

Latest Equipment

Other

Thank you for your time. We trust you enjoy your experience with us at Le Beau.