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Action needed — New client paperwork

Please complete your health history and consent forms before your first visit. This only takes a few minutes and keeps your file current.

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Services

Massage therapy

Facials & esthetics

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Date & time

Available times

Select a date to see available times.

Your details

First name

Last name

Phone

Notes for your therapist (optional)

Guests

Adding a guest lets you assign specific services to them. Each guest will have their own record at Awaken Zen.

Cancellation policy & card on file

We require 24 hours notice to cancel or reschedule your appointment. A $25 no-show fee will be charged to the card on file if notice is not provided. Your card will not be charged until the day of your appointment.

I understand and agree to the cancellation policy.

This appointment is a surprise — please skip sending intake & consent forms to my guest.

Pre-pay your visit optional Charge today & apply to a gift card on file for flexibility

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Services$0

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Total charged today$0

Payment will be tracked internally and credited to your account for full flexibility on rescheduling.

A card is required to hold your appointment. It will not be charged now — stored securely by Square and only used if a no-show fee applies. If pre-paying, your card will be charged the amount shown above today.

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Your visit

Select services to start building your visit.

Add a guest

Their details will be saved to your booking at Awaken Zen.

First name

Last name

Phone

Progress timeline

A running record of your body's story — what we found, what we worked on, and how you're improving.

Focus areas — current snapshot

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Session history

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New client paperwork

Complete your health history and consent forms before your first visit. Your information is stored securely and shared only with your therapist.

Paperwork submitted — your information is on file. Contact us if you need to make changes.

Client Information

First Name

Last Name

Phone

Appointment Date

Is this appointment for a minor (under 18)?

Yes No

Health & Medications

Are you currently pregnant?

Yes No

Medications relevant to massage?

Blood Pressure Medication Daily Aspirin Pain Medication Sleep Aids Muscle Relaxers None

Medical conditions (check all that apply)

Cancer Headaches / Migraines Arthritis Diabetes Neuropathy Joint Replacement High / Low Blood Pressure Fibromyalgia Stroke Heart Attack Kidney Dysfunction Blood Clots Numbness Open Wounds Muscle / Tendon Ruptures Partial Tendon Tears Contusions (Bruises) Burns Broken Bones Sprains & Strains Gout Bursitis Skin / Soft Tissue Infections Aneurysms Varicose Veins Artificial Blood Vessels Bleeding Disorders Tumors None / Unaware of any conditions

Please explain any conditions that apply

I have disclosed all of the above information and guarantee its accuracy.

Injuries & Areas of Focus

Allergies or Sensitivities

Recent Injuries

Where do you carry your tension and/or pain?

Implanted birth control device in your arm?

No / Does not apply Yes — Left Arm Yes — Right Arm

Session Preferences

Type of service

Therapeutic & Relaxation Combo Therapeutic Relaxation

Pressure preference

Light Medium Deep

Primary area of concern / pain

Shoulders & Upper Back Middle & Lower Back Neck & Head Hands & Arms Feet & Legs Hips

Secondary area (if applicable)

Shoulders & Upper Back Middle & Lower Back Neck & Head Hands & Arms Feet & Legs Hips N/A

How do you want your time divided?

Time evenly for a full-body treatment Full-body treatment with focus to area Focus on a specific problem, skip areas as needed

Areas you do not want massaged

Hip / glute work preference

N/A — no hip or glute work Direct work with proper draping is okay Completed through the sheet / clothing is okay

Open to stretches being included?

Yes No

Massage Mediums

Medium application

No Medium (required for some treatments) Light Application Standard Application Generous Application

Massage base (choose one)

Grapeseed Oil Sweet Almond Oil Coconut Oil Lotion Body Butter

Essential oil (choose one)

None Lavender + Mint Blend Citrus Blend Grapefruit Spearmint Lavender Sweet Orange Lemon

Special requests or goals

Paperwork submitted — your information is on file. Contact us if you need to make changes.

Client Information

First Name

Last Name

Phone

Appointment Date

Minor appointment?

Yes No

Skin History

Allergies or Sensitivities

Estimated daily sun exposure

30 minutes or less 1–2 hours 3–4 hours 5 hours or more

Have you had a facial before?

Yes No

When was your last facial? (optional)

Current home care regimen

No home care regimen Yes — cleanser only Yes — SPF only Yes — cleanser and moisturizer / SPF Yes — cleanser, toner, and moisturizer / SPF Yes — full regimen with serums

Regimen consistency

N/A Daily Weekly Sparingly

Medical Conditions & Medications

Some medications and conditions affect how we can treat your skin. Please check everything that applies.

Medication: Accutane Medication: Differin Medication: Tazarac Medication: Azelex Medication: Renova Use of AHA / BHA Peels Use of Retin-A Products Pregnancy Immune Deficient Cardiac Problems / Pacemaker High Blood Pressure Blood Clots Botox or Other Injectables Cancer Hormone Replacements Epilepsy Kidney Problems Diabetes None / Unaware of any conditions

Please explain any conditions that apply

I have disclosed all of the above information and guarantee its accuracy. I cannot hold Awaken Zen Spa legally responsible if an issue arises from undisclosed information.

Skin Concerns & Goals

Skin conditions that concern you

Hyperpigmentation Acne Redness Rosacea Sensitivity Oiliness Dryness Clogged Pores Flaking Skin Aging Skin

Interested in skin care education?

No thank you Yes — after the session only Yes — during and after the session is okay

Specific requests or goals

Health update

Let your therapist know if anything has changed — health conditions, medications, injuries, or session preferences. Update this any time.

Health update saved — expand any section to review. Update any time your health or preferences change.

Health & Medications

Are you currently pregnant?

Yes No

Medications relevant to massage?

Blood Pressure Medication Daily Aspirin Pain Medication Sleep Aids Muscle Relaxers None

Medical conditions (check all that apply)

Please explain any conditions that apply

Injuries & Areas of Focus

Allergies or Sensitivities

Recent Injuries

Where do you carry your tension and/or pain?

Implanted birth control device in your arm?

No / Does not apply Yes — Left Arm Yes — Right Arm

Session Preferences

Type of service

Therapeutic & Relaxation Combo Therapeutic Relaxation

Pressure preference

Light Medium Deep

Primary area of concern / pain

Shoulders & Upper Back Middle & Lower Back Neck & Head Hands & Arms Feet & Legs Hips

Secondary area (if applicable)

Shoulders & Upper Back Middle & Lower Back Neck & Head Hands & Arms Feet & Legs Hips N/A

How do you want your time divided?

Time evenly for a full-body treatment Full-body treatment with focus to area Focus on a specific problem, skip areas as needed

Areas you do not want massaged

Hip / glute work preference

N/A — no hip or glute work Direct work with proper draping is okay Completed through the sheet / clothing is okay

Open to stretches being included?

Yes No

Massage Mediums

Medium application

No Medium Light Application Standard Application Generous Application

Massage base (choose one)

Grapeseed Oil Sweet Almond Oil Coconut Oil Lotion Body Butter

Essential oil (choose one)

None Lavender + Mint Blend Citrus Blend Grapefruit Spearmint Lavender Sweet Orange Lemon

Special requests or goals

Health update saved — expand any section to review. Update any time your health or preferences change.

Skin & Health

Are you currently pregnant?

Yes No

Skin type

Normal Dry Oily Combination Sensitive

Skin concerns (check all that apply)

Acne / Breakouts Rosacea Hyperpigmentation Fine Lines / Wrinkles Dullness / Uneven Tone Dehydration Eczema / Psoriasis None

Allergies or product sensitivities

Current skincare medications (e.g. Accutane, Retin-A, retinoids)

Session Goals & Preferences

Primary goal for today's session

Relaxation & stress relief Anti-aging & firming Brightening & evening skin tone Acne clearing & pore refinement Deep hydration

Special requests or notes for your esthetician

My Files

Your intake forms, consent agreements, and session documents — stored securely and available any time.

Intake Forms

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Consent Forms

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Session Reports

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Consent forms

Please review and sign your consent agreements. These are kept on file and only need to be renewed if your situation changes or when we prompt you.

✓ Consents on file — Your signed forms are stored securely. You only need to re-sign if we notify you of an update, or if something changes.

Consent on file. Contact us if you need to make changes.

Consent to Receive Massage

I authorize and request massage treatments from Awaken Zen Spa. I understand that I can disrobe to my comfort level, and that clothed areas may require different massage techniques.

I consent to receiving massage treatment.

HIPAA Disclosure

I have reviewed the HIPAA disclosure at www.awakenzenspa.com. I understand my rights and consent to how my personal information will be handled in accordance with HIPAA guidelines.

I have reviewed and consent to the HIPAA disclosure.

No-Show Policy

I understand the therapist will call my listed phone number. If I don't answer or arrive within 20 minutes of the scheduled time, the appointment will be marked as a no-show and a $25 non-refundable fee will be charged to my card.

I understand and agree to the no-show policy.

Payment Authorization

I agree to pay Awaken Zen Spa for services rendered. If paying by card, I authorize Awaken Zen Spa to process my payment with the card I provided.

I agree to pay for services received.

Nature of Massage Therapy

I understand that therapeutic massage is not a substitute for traditional medical treatment. The massage therapist does not diagnose illnesses or prescribe medications. I have clearance from my physician to receive massage therapy.

I acknowledge the nature of massage therapy.

Risks, Conduct & Liability

I understand massage carries risks including superficial bruising, muscle soreness, and worsening of unknown injuries. I release Awaken Zen Spa and the therapist from liability. I understand that either party may terminate the session at any time, and that services are for therapeutic relief only — not sexual in nature.

I understand and accept all associated risks and conduct expectations.

Accuracy & Final Agreement

I confirm all information provided is accurate and complete, and will keep my therapist informed of any changes to my medical conditions or medications.

All information provided is correct and I agree to all of the above.

By initialing, I confirm I have reviewed all items above and release Awaken Zen Spa from legal liability for any undisclosed information.

Signature

Electronic signatures are valid as originals for all purposes.

Business Signature

Owner

Brant Pewonka

Signature

Brant Pewonka

Your Full Name

Your Signature

Sign above

Date

Consent on file. Contact us if you need to make changes.

Consent to Receive Facial Treatment

I authorize and request facial treatments from Awaken Zen Spa.

I consent to receiving facial treatments.

HIPAA Disclosure

I have reviewed the HIPAA disclosure at www.awakenzenspa.com. I understand my rights and consent to how my personal information will be handled in accordance with HIPAA guidelines.

I have reviewed and consent to the HIPAA disclosure.

Service Upgrades

I understand that opting for an upgraded service during my visit may incur additional cost, and that verbal consent by me will be sufficient notice of the change in price.

I acknowledge that upgrades may affect the final price.

No-Show Policy

I understand and agree to the no-show policy.

Payment Authorization

I agree to pay Awaken Zen Spa for services rendered. If paying by card, I authorize Awaken Zen Spa to process my payment with the card I provided.

I agree to pay for services received.

Accuracy & Final Agreement

I confirm that all information provided is accurate and complete. I understand that Awaken Zen Spa is held harmless from all legal liability if information was not disclosed.

All information provided is correct and I agree to all of the above.

By initialing, I confirm I have reviewed all items above and release Awaken Zen Spa from legal liability for any undisclosed information.

Signature

Electronic signatures are valid as originals for all purposes.

Business Signature

Owner

Trevor Millar

Signature

Trevor Millar

Your Full Name

Your Signature

Sign above

Date

Membership

Your membership details, benefits, and billing history.

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Zen Core Member

● Active

Monthly$69

Banked0

Renews—

⚠ Your last membership payment didn't go through. Please update your payment method in Square to avoid interruption. Update now

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Services

Billing

Perks

Manage

Banked Services

Service Log

Payment History

Zen Core includes

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One 60-min service monthly

Massage or facial — your choice each month

✓

Additional hours at $69

Stack services same-day for the combo rate

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15% off retail products

Applied automatically at checkout

✓

Pause anytime

No contracts. Life happens.

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Spouse / partner perk

One designated guest may redeem your included monthly service

Spouse / Guest

Your monthly included service can be used by one designated spouse or partner. Update anytime.

Designated guest

Membership Controls

Changes take effect at the end of your current billing period on —.

No-Show Policy

A $25 late cancellation / no-show fee applies to all appointments cancelled within 24 hours or missed without notice. Acknowledged at membership signup.

Auto-Pause Policy

When you accumulate 3 banked services, your membership pauses automatically. You'll receive a reminder at 1 and 2 banked services. Resume anytime — your credits stay with you.

Zen Core · Paused

⏸ Paused

Banked0

StatusPaused

⏸ Your membership has been paused. Use your banked services then resume below.

Ready to resume?

Your banked services are waiting. We recommend booking before resuming so credits don't continue to accumulate.

^$69/mo

One 60-min service · 15% off everything · Pause anytime

One-time enrollment fee: $99

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One 60-min massage or facial monthly

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Additional hours at the member rate of $69

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15% off all retail products

✓

Spouse / partner guest perk

✓

No contracts · Pause or cancel anytime

Join Zen Core

$69/mo · $99 one-time enrollment fee · $168 charged today

Spouse / Guest (optional)

You can add or update this anytime after joining.

Membership Terms

Monthly Billing. Your card on file will be charged $69 on the same date each month. The first charge includes the $99 one-time enrollment fee ($168 total today).

Included Service. One 60-minute massage or facial is included each month. Unused services bank up to 3. At 3 banked, your membership auto-pauses until you book.

Additional Services. Additional services on the same day are billed at the member rate of $69/hr. Retail products are discounted 15%.

Spouse / Guest Perk. One designated guest may redeem your included monthly service. You may update your guest at any time.

No-Show & Late Cancellation. A $25 fee applies to appointments cancelled within 24 hours or missed without notice. By joining, you pre-authorize this fee to be charged to your card on file.

Pause & Cancel. You may pause or cancel at any time from this portal. Changes take effect at the end of your current billing period. Banked services remain available for 90 days after cancellation.

I have read and agree to the membership terms, including the $25 no-show / late cancellation policy. I authorize AZS to charge my card on file.

I understand that a $25 fee will be charged for missed appointments or cancellations within 24 hours.

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Pause your membership?

Your membership will pause at the end of your current billing period on —. You won't be charged again until you resume. Banked services stay with you.

Cancel membership?

Your membership will cancel at the end of your current billing period on —. Banked services remain available for 90 days. We'd love to have you back anytime.

Resume membership?

Your membership will resume immediately. Your next billing date will be set 30 days from today. Banked services remain available.

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Guest full name

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Personalized guidance from your therapist to maximize the work we do together — built around your current treatment focus.

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