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Spa · Houston
2613 Potomac Drive, Houston, TX 77057

Guest Intake & Consultation

Welcome to Fiori Spa. Texas law requires a written consultation before your first massage, and your answers help your therapist or esthetician tailor today's service safely. Everything you share is kept confidential and stored securely.

Is this your first visit to Fiori Spa?

Welcome back

Tell us who you are and what you're here for today. If nothing about your health has changed since your last visit, you can skip the long form.

Please enter your full name.
Please enter your date of birth so we can match your record.
We don't see a previous digital form under that name and birthdate — if you filled out a paper form on an earlier visit, that's perfectly fine. You can continue below.

Today's visit

Please choose today's service.
Returning guest / member — no changes

I have completed this form before, and I confirm both of the following:

To use the short form, please confirm both statements — or use “Something has changed” below to update your form.

Guest Intake & Consultation

Please complete the sections below for today's service.

1 · About you

Please enter your full name.
Please enter your date of birth.
Please enter your cell phone number.

3 · Today's visit

Please choose at least one service for today.

4 · Health history — massage Receiving massage

Please check anything that applies to you, now or in the past:

Please be sure to list any blood thinners or anticoagulants — they affect pressure and bruising during massage.

5 · Skin history — facials Receiving a facial

Please check anything that applies:

Fiori may take photos for my treatment record.

My photos may be used in Fiori marketing.

6 · Please read — your session, your rights Includes Texas-required statements

  • Draping. Your therapist will drape the genital area and gluteal cleavage at all times, for every guest. The breasts of female guests will be draped at all times; breast massage is not performed at Fiori Spa.
  • You can stop at any time. If you are uncomfortable for any reason, you may ask your therapist to cease the massage, and the therapist will end the session.
  • Your therapist can stop, too. Your therapist may end the session if the therapist feels uncomfortable for any reason.
  • Sexual contact ends the session immediately. If a guest initiates any verbal or physical contact that is sexual in nature, the therapist must end the session at once.
  • What massage is — and is not. Massage is for stress reduction, relief of muscular tension, and improved circulation. Massage therapists do not diagnose illness or disease, do not prescribe medication, and do not perform spinal manipulation. Please see a physician for any ailment or condition.
  • Tell us during your session. Please let your therapist or esthetician know right away about any pain or discomfort, and keep us updated whenever your health, medications, or conditions change.
  • Facials and skin safety. Under Texas rules, we may not perform facial services on skin that is inflamed, infected, or broken, or on a guest with a contagious condition in the area to be treated. Your esthetician may postpone a treatment to protect your skin.
  • Guests under 17. A parent or guardian's written consent is required before massage (Texas law) and before facial services (spa policy).
  • Cancellations. Appointments cancelled within 24 hours are charged in full. Rescheduling is always welcome and is never charged.
Please check the box to confirm you have read and understand these statements.
Complaints: Massage services at Fiori Spa are regulated by the Texas Department of Licensing and Regulation. Complaints may be directed to the Texas Department of Licensing and Regulation, P.O. Box 12157, Austin, TX 78711-2157 · (512) 463-6599 · (800) 803-9202 · www.tdlr.texas.gov. Your information on this form is kept confidential, maintained securely, and retained as Texas law requires.

7 · Signatures

By signing, I confirm that the information I have given is complete and accurate, that I have read Section 6, and that I consent to the services described for today's visit.

Please type your full name.
Date:
Please sign in the box above.
✓

Thank you — your form is complete.

Today's check-in word
IVORY

Show this screen to the front desk before your service.

Your therapist will review and sign your consultation with you.

Front desk

Staff only. Enter the front-desk PIN to see today's forms.

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Today's Forms

Submission

For your therapist / esthetician to complete
Please complete all therapist fields and sign before marking complete.
Your information is kept confidential, maintained securely, and retained as Texas law requires.