Voucher number and which value or treatment written on your voucher
Purchaser Full Name
Treatments or Package - Please refer to the treatment menu, and write the correct name of treatment or package (& check prices), by reviewing and clicking on the gold treatment menu button above
Anything we need to know, questions or concerns you may have?
Customer(s) - If booking in two people or a couples package, please provide both names, mobile and email for each person
Person 1 - Full Name
Person 1 - Mobile to receive your appointment reminder (please no landline numbers)
Person 1 - Email Address
Person 2 - Full Name
Person 2 - Mobile to receive your appointment reminder (please no landline numbers)
Person 2 - Email Address
Must select two future dates
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Preference 2
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Preferred Time
Mon - Fri 10am - 12pm
Mon - Fri 1pm - 6pm
Sat 9am - 12pm
Sat 1pm - 3pm
Please advise more information i.e. when you can arrive & need to depart plus any time restrictions i.e. available all day or finish work 3pm or must leave by 2pm
Suburb, State & Postcode
Date of Birth
Your Age - (For facial bookings please fill out the consultation information to help select appropriate facial treatments)
If you're pregnant and how many weeks? (Massage bookings). Write N/A if not pregnant
Facial clients - Age, recent cosmetic treatments or facials & skin care using - want to improve
Any injuries, recent operations or medical conditions
Pressure for your massage light, medium or firm And where you would like the therapist to focus ie shoulders or lower back
Massage clients - describe where you have muscle aches or joint pain and wish to focus on & improve
Please fill in all * questions prior to submitting, or we won't receive your submission. Please take a screenshot of your completed form, in case we don’t receive it. Please follow up if no response after 48 business hours and email your screenshot to reception@cullenbaydayspa.com.au
B
SUBMIT
