SPA CONSULTATION FORM

Please complete the form below ahead of your stay

Title

First Name

Last Name

Email

Phone

Street Address

City

County

Postal Code

Select County

Occupation

Date of Birth

Emergency Contact

Emergency Contact Number

Anything you think we should know about?

If you ticked any of the above, please give us a little more detail.

Medication

Please provide details

Skin Story

Skin type

Have you ever used Roaccutane, Accutane or Retinin A?

Yes

No

Have you recently had any cosmetic enhancements, such as botox, fillers or any other?

Yes

No

Massage / body treatments

Your permission

Please sign in the box below

Signature field — to be added (Designer / custom)

Signed date

If you are a child aged 16 or 17, you will need parental consent. Please ask your parent to check and sign this form below.

Full Name

Relationship

I can confirm that I have read and understood the terms and conditions.

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32 bedrooms and a private bar, spa and restaurant

North Street, Langham,
Norfolk, NR25 7DH

01328 805000stay@theharper.co.ukwork@theharper.co.uk
© 2026 The Harper Hotel