Name *

First Name

Last Name

Phone *

(###)

###

####

Treatment Add On?

Choose one or more below to add on to your spa services. *Denotes specific add-ons that can only be added to facial treatments.

Pumpkin Peel (seasonal)*

Olive Oil & Rosemary Scalp Treatment

Green Tea Eye Treatment*

Hand Exfoliation

Foot Exfoliation

Organic Peel*

High-Frequency Wand*

Pure Glow Oxygen Treatment

Is this Appointment for a Male or Female?

Male

Female

Preferred Appt. Date

MM

DD

YYYY