BEAUTIFYING ONCOLOGY SPA SERVICES

New Client Intake Form

Personal Information

Today's Date

First name

Last name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Email

Birthday

Month

Day

Year

Emergency Contact (Name & Phone)

Cancer/Treatment, History Section

What type/stage of cancer have you been diagnosed with, and when did you receive your diagnosis?

What is the current status of your cancer?

Active

In Remision

N/A

Please specify the location of your cancer (e.g., breast, lungs, etc.):

When was your last treatment date?

Briefly, please describe your treatment history, including any past treatments and whether you are currently undergoing any active treatment (e.g. chemotherapy, radiation)

What oncology medications are you currently taking? Are you experiencing any side effects from your medications? If yes, please specify

Have you had any lymph nodes removed or radiated? If so, please specify how many, their locations, and the dates of the procedures.

If other or allergies, please describe below. Please list additional health concerns/conditions below

Are your current lab counts normal?

Yes

No

Current non-oncology medications or supplements that are being taken?

Name of facility where you are/were being treated

Additional Information

What are your three primary skin care goals or concerns?

Have you previously received any facial services? If yes, please indicate when. Did you experience any complications?

Were you referred to us? If so, please share the name of the person or organization that referred you.

Our Services

Oncology Facial

Discover our specially designed oncology facial, crafted to address the unique needs of individuals at various stages of cancer treatment. This calming facial gently nourishes and repairs the skin, ensuring a safe and supportive experience throughout your healing journey. This facial includes a thorough cleansing, gentle extractions, a healing massage, and a soothing mask to further enhance your comfort and rejuvenation.

Oncology Massage

Every massage is tailored to your specific needs — whether you're managing stress during treatment, dealing with scar tissue, cording, or general aches after surgery. Whatever you're experiencing, we'll create a plan to get you feeling as good as possible. A doctor's note is required.

Reiki

Reiki is ideal for individuals who are unable to receive traditional massage therapy, offering relaxation, supportive care, and stress relief.

Reiki is a gentle, energy-focused therapy that provides emotional and nervous system support for individuals undergoing cancer treatment and recovery. This practice involves either light touch or hands positioned just above the body. By promoting profound relaxation, Reiki helps alleviate stress, fosters a sense of calm, and supports overall wellness during challenging periods.

Wig Cutting

We provide expert wig cutting services to help you embrace your new hairstyle with confidence. Our skilled stylists will craft a personalized wig style that ensures a natural and glamorous appearance, making you feel fabulous every step of the way.

Oncology Manual Lymphatic Drainage

Surgery — whether curative or preventative — can leave you swollen, bruised, and uncomfortable. MLD helps reduce swelling, speed healing, and ease your body back to feeling like itself. When lymph nodes are removed, it can also help prevent or slow lymphedema. Its gentle, rhythmic technique has a calming effect on the nervous system, so you leave feeling relaxed as well as restored. Red light therapy is available if needed. A doctor's note is required.

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