New Client Intake — Sacred Moroccan Wellness

Personal Details

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth

Location / Area

How did you hear about SMW?

Referred by (name, if applicable)

Health Information

Why we ask: Our treatments involve exfoliation, heat, argan oil (tree nut derivative), black soap and clay. It is essential we know about any health conditions, allergies or contraindications to keep you safe and ensure you receive the best possible experience.

Allergies (please detail)

Any other health conditions or medications we should know about?

Skin type

Treatment Preferences

Pressure preference for massage

Areas of focus or concern

Anything else you'd like your therapist to know?

Consent & Communications

I confirm that the health information I have provided is accurate and complete to the best of my knowledge. I understand it is my responsibility to inform Sacred Moroccan Wellness of any changes to my health before future appointments. *

I consent to receiving wellness treatments from Sacred Moroccan Wellness and acknowledge that all treatment recommendations are made in good faith based on the information I have provided. *

I understand that my personal data will be stored securely and used only to manage my appointments and provide personalised treatments. It will not be shared with third parties. *

I'd like to receive occasional updates, offers and wellness news from Sacred Moroccan Wellness by email. (Optional — you can unsubscribe at any time.)