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Reservation Request Form

Please remember this is a request for a reservation. Filling out this form does not confirm your reservation.
*Required

Please review and complete our questionnaire before submitting your reservations form.

Please note that you may not be able to receive treatments if you have particular health conditions. Please feel free to contact us with any questions or concerns. (808) 922-5115

Dr. Body Health Questionnaire

 Welcome to Dr. Body! To provide you with the best possible experience and to assure your maximum safety and comfort, please complete our brief health questionnaire to assist the therapists. We encourage you to disclose any pertinent health conditions that may affect your experience here at Dr. Body. Please check any boxes and list any specific conditions that may apply in the space provided below.

  •  I am currently pregnant or there is a possibility that I could be weeks pregnant.
  •  I will be on day of my menstruation cycle.
  •  I am wearing contact lenses:
  •  I am currently on medication or receiving medical treatment
  • Please specify your medical condition:
  • Please check any conditions that you are currently experiencing:
    •  Low Blood Pressure
    •  High Blood Pressure
    •  Diabetes
    •  Clotting disorders
    •  Heart disease/condition
    •  Hernia
    •  Osteoporosis
    •  Uterine Fibroids
    •  Joint injury/pain
    •  Neck injury/pain
    •  Spinal injury/pains
    •  Skin disorders/infections:
  • I have an allergy:
    Please specify if you have any allergies:
  •  I bruise easily
  •  I have recently undergone medical surgery:
    Please indicate type of surgery:
  •  I have recently undergone cosmetic surgery:
    Please indicate type of surgery:
  • Please check if you have any of the following:
    •  Pacemaker
    •  Hearing Aid
    •  Braces
    •  Metal Implants
    • Others:
  • *Please circle your preferred pressure during treatment:

DISCLAIMER:
Please inform the therapist immediately if you experience any discomfort or concern during your treatment. Please be advised that individual results may vary. This business establishment will not be held liable for any injury or condition that arises from application of any treatments performed despite completion of this form. Dr.Body, Inc’s treatment should not be treated as a medical procedure. This form is intended as an assessment tool that is routinely used in the spa profession and serves as a guide for applications of the treatment. We do not share any of the provided information to a third party.

*Client Declaration:
I have stated all conditions that I am aware of and that this information is true and accurate to the best of my knowledge. I agree to inform my therapist of any changes in conditions as stated above. I acknowledge that this information will be confidential and held by Dr.Body., Inc, and will only be used in conjuction with treatments I receive at Dr.Body, Inc and that Dr.Body, Inc is not held liable for the management or arising conditions.

Cancellation Policy

We value your business and appreciate your cooperation with our cancellation policy. Please respect our scheduling by keeping appointments whenever possible and providing a minimum of 72 hours notice when canceling or rescheduling appointments. Because your services are guaranteed reservations reserved for you, reservations cancelled or rescheduled less than 72 hours before the date of service will incur the following charges:

  • Less than 72 hours before appointment: 20%
  • Less than 48 hours before appointment: 50%
  • Less than 24 hours before appointment: 100%
  • No-show or missed appointments: 100%
  • Late arrivals - please keep in mind that arriving late for a service may require us to shorten the length of the treatment, with full charges applied, so as not to inconvenience other guests. We regret that late arrivals will not receive extension of scheduled appointments. When booking your appointments within 72 hours Changes or Cancellations will be subject to a fee.
  • Please arrive 15 minutes prior to your appointment time.

Cancel or Reschedule by Phone:
(808) 922-5115

Open Hours:
10:00 AM - 10:00 PM
(Last appointment at 7:00 PM)
*Reservation Required