NORTHERN MASSAGE & SPA NORTHERN MASSAGE & SPA NORTHERN MASSAGE & SPA

NAME: _____________________________________ DATE: _________________________ NAME: _____________________________________ DATE: _________________________ NAME: _____________________________________ DATE: _________________________

ADDRESS: __________________________________________________________________ ADDRESS: __________________________________________________________________ ADDRESS: __________________________________________________________________

GENDER: ________ BIRTHDAY: ______________CONTACT #: _______________________ GENDER: ________ BIRTHDAY: ______________CONTACT #: _______________________ GENDER: ________ BIRTHDAY: ______________CONTACT #: _______________________

PREFFERED THERAPIST (TAGA MASAHE) PREFFERED THERAPIST (TAGA MASAHE) PREFFERED THERAPIST (TAGA MASAHE)
 MALE (LALAKE) ______ FEMALE (BABAE)______ REQUEST _______________  MALE (LALAKE) ______ FEMALE (BABAE)______ REQUEST _______________  MALE (LALAKE) ______ FEMALE (BABAE)______ REQUEST _______________

HEALTH CONDITION HEALTH CONDITION HEALTH CONDITION

Please Check ( ) the following: Please Check ( ) the following: Please Check ( ) the following:
_____ Fever _____ High Blood _____ Cancer _____ Fever _____ High Blood _____ Cancer _____ Fever _____ High Blood _____ Cancer
_____ Diabetes _____ Gout _____ Skin Diseases _____ Diabetes _____ Gout _____ Skin Diseases _____ Diabetes _____ Gout _____ Skin Diseases
_____ Fracture Bones _____ Stroke _____Bone Problems _____ Fracture Bones _____ Stroke _____Bone Problems _____ Fracture Bones _____ Stroke _____Bone Problems

____ YES ____NO Are you pregnant (for female only) ____ YES ____NO Are you pregnant (for female only) ____ YES ____NO Are you pregnant (for female only)
____YES ____NO Did you undergo medical operation? ____YES ____NO Did you undergo medical operation? ____YES ____NO Did you undergo medical operation?
____YES ____NO Are you drunk? ____YES ____NO Are you drunk? ____YES ____NO Are you drunk?
____YES ____NO Is your stomach full? ____YES ____NO Is your stomach full? ____YES ____NO Is your stomach full?

CONSENT CONSENT CONSENT

Sa aking pag lagda binibigyan ko ng karapatan ang masahista na isagawa
ang naturang pagmamasahe, akin ding nauunawaan na may mga bagay na bawal
at hindi dapat gawin sa panahon ng pagmamasahe. Anumang bagay na aking
gagawin na labag sa patakaran ng Northern Massage & Spa, ay maaaring
magpatigil sa pagmamasahe at babayaran ng buo ang naturang serbisyong kinuha .
Sa aking pag lagda binibigyan ko ng karapatan ang masahista na isagawa
ang naturang pagmamasahe, akin ding nauunawaan na may mga bagay na bawal
at hindi dapat gawin sa panahon ng pagmamasahe. Anumang bagay na aking
gagawin na labag sa patakaran ng Northern Massage & Spa, ay maaaring
magpatigil sa pagmamasahe at babayaran ng buo ang naturang serbisyong kinuha .
Sa aking pag lagda binibigyan ko ng karapatan ang masahista na isagawa
ang naturang pagmamasahe, akin ding nauunawaan na may mga bagay na bawal
at hindi dapat gawin sa panahon ng pagmamasahe. Anumang bagay na aking
gagawin na labag sa patakaran ng Northern Massage & Spa, ay maaaring
magpatigil sa pagmamasahe at babayaran ng buo ang naturang serbisyong kinuha .

_________________________________ _________________________________ _________________________________

Printed Name and Signature Printed Name and Signature Printed Name and Signature

SERVICES: ___________________________________ CLIENT’S NUMBER_______________ SERVICES: ___________________________________ CLIENT’S NUMBER_______________ SERVICES: ___________________________________ CLIENT’S NUMBER_______________

PRICES: ____________________________________________ TOTAL BILL: _____________ PRICES: ____________________________________________ TOTAL BILL: _____________ PRICES: ____________________________________________ TOTAL BILL: _____________

TIME OF TREATMENT: START: _____________ ETE: _____________ ATE: _____________ TIME OF TREATMENT: START: _____________ ETE: _____________ ATE: _____________ TIME OF TREATMENT: START: _____________ ETE: _____________ ATE: _____________

TIME OF MASSAGE: START: _____________ ETE: _____________ ATE: _____________ TIME OF MASSAGE: START: _____________ ETE: _____________ ATE: _____________ TIME OF MASSAGE: START: _____________ ETE: _____________ ATE: _____________

RECEPTIONIST: _____________ CASHIER: ______________ THERAPIST: _______________ RECEPTIONIST: _____________ CASHIER: ______________ THERAPIST: _______________ RECEPTIONIST: _____________ CASHIER: ______________ THERAPIST: _______________

TO OUR VALUED CLIENTS, TO OUR VALUED CLIENTS, TO OUR VALUED CLIENTS,

UGALIING TIGNAN KUNG TAMA ANG ORAS NA BINIGAY NA SERBISYO NG TAGA UGALIING TIGNAN KUNG TAMA ANG ORAS NA BINIGAY NA SERBISYO NG TAGA UGALIING TIGNAN KUNG TAMA ANG ORAS NA BINIGAY NA SERBISYO NG TAGA
MASAHE. KUNG ANG IBINIGAY NA SERBISYO NG TAGA MASAHE AY MAS MABABA MASAHE. KUNG ANG IBINIGAY NA SERBISYO NG TAGA MASAHE AY MAS MABABA MASAHE. KUNG ANG IBINIGAY NA SERBISYO NG TAGA MASAHE AY MAS MABABA
SA NAKATAKDANG ORAS, ITO AY LIBRE. THANK YOU FOR CHOOSING US! SA NAKATAKDANG ORAS, ITO AY LIBRE. THANK YOU FOR CHOOSING US! SA NAKATAKDANG ORAS, ITO AY LIBRE. THANK YOU FOR CHOOSING US!