Is the person booking the appointment the same person receiving the service? Is the person booking the appointment the same person receiving the service? Yes If no then please type the name of the person receiving the service in the name, email and phone fields:

Name* (please use same name/email if returning client)

Email Address*

Requested Service Date

Requested Service Time

Phone Number*

Can we text you at this number? Can we text you at this number? Yes No

Are you a new client? Are you a new client? Yes No

Is person receiving the service a minor? Minors 16 and over can receive massages (guardian must be in room if 16-18), and 14-18 for facials (guardian in building). **A Minor Consent form will be required before service.** Is person receiving the service a minor? Minors 16 and over can receive massages (guardian must be in room if 16-18), and 14-18 for facials (guardian in building). **A Minor Consent form will be required before service.** Yes they are a minor No they are not a minor

Are you a Spa Member? Are you a Spa Member? Yes No

Please list a staff member if you have a special request:

Are you flexible? Are you flexible? Yes No

What service are you requesting (write name and length of service)?

Would you like an Enhancement with your service? Would you like an Enhancement with your service?Facial: LED Nap - 15 min, $35Face: Hair & Scalp Revitalizer w/ Gua Sha - $25Face: Microcurrent - $25Face: Facial Cupping - $22Body: Deep Tissue - $15Body: CBD Oil Upgrade - $12Body: Hair & Scalp Revitalize, 15 min - $20Massage: Cupping - $15Body: Dry Brushing - $15None

Add another service: Add another service: No Yes

What additional service are you requesting (write name and length of service)?

Would you like an Enhancement with your additional service? Would you like an Enhancement with your additional service?Face: LED Nap - 15 min, $35Face: Seasonal Peel - $20Face: Hair & Scalp Revitalizer - $20Face: Micro-current - $25Face: CBD Serum + Lymphatic Drainage - $20Face: Hand Facial - $15Body: Deep Tissue - $15Body: CBD Oil Upgrade - $12Body: Hair & Scalp Revitalize, 15 min - $20Body: Cupping - $15Body: Dry Brushing - $15None

Are there additional guests? Provide names and services they are interested in. For groups of 3 or more please email us at concierge@anjouspa.com Are there additional guests? Provide names and services they are interested in. For groups of 3 or more please email us at concierge@anjouspa.com No Yes (please list names below)

Additional Guests Names

Please leave additional comments and notes about your requests so we can match you with the best possible time and staff. If you are a Spa Member, please let us know if you'd like an add-on or enhancement upgrade to your member service.

Please acknowledge these important Anjou Spa policies: COVID screenings are in effect, even if you have received a vaccine. Mask required for all treatments (except during facials). Call or text us at 541-241-8454 upon arrival to let us know you have arrived. Minors younger than 15 must have a parent or guardian at the spa at time of service. Please acknowledge these important Anjou Spa policies: COVID screenings are in effect, even if you have received a vaccine. Mask required for all treatments (except during facials). Call or text us at 541-241-8454 upon arrival to let us know you have arrived. Minors younger than 15 must have a parent or guardian at the spa at time of service. I agree.