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Scheduled Treatment Date:
What Service will you be receiving?
What is your primary reason for the service you will be receiving by TWP?
Have you received any type of spa services before?
No Yes   (if yes, please specify below)
Are there any areas you would like the therapist to avoid?
Are there any areas you would like the therapist to focus on specifically?
Are you currently on any medications?
No Yes   (if yes, please specify below)

Do you have any allergies?
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Have you had any recent surgeries or injuries?
No Yes   (if yes, please specify below)
Do you have any blood-borne diseases or any infections?
No Yes   (if yes, please specify below)
Do you have any questions or concerns regarding the service you are going to recieve?
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Corporate Profile
Florida Inquiries:
401 East Las Olas blvd. Ste. 130-288
Fort Lauderdale, FL 33301
Ali Hecht
954-732-0517
info@totalwellnessprofessionals.com
www.myspace.com/totalwellnesspros

California Inquiries:
11432 Via Playa de Cortes
San Diego, CA 92124
Stephanie Kass
858-449-9161
stephanie@totalwellnessprofessionals.com

Service Locations:
Fort Lauderdale, FL
Miami, FL
West Palm Beach, FL
San Diego, CA
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Gift Certificates Now Available!
Gift certificates can be purchased through PayPal and are available in $50 increments. Gift certificates can be used for any TWP service.
Click Here to learn more!