Relax, Restore,Reconnect.

Relax, Unwind & Let Us Take Care of You

Please complete the consent form before your treatment.

First Name *

Last Name *

Phone *

Whatsapp number

Email *

Date of birth

City

How did you hear about us? *

Any surgery in the past 5 years?

Do you have any health condition, injury, allergy, pregnancy, medication, recent surgery or other circumstance that may affect your spa treatment or that your therapist should know about for your safety? *

If yes, please only provide information relevant to your treatment:

Do you have any known allergies or sensitivities that may be affected by spa products? *

If yes, please provide only the information necessary for your treatment:

Do you currently have any skin condition or affected area that the therapist should be aware of? *

1. Treatment Consent *

By clicking here, I voluntarily consent to receiving the selected spa treatment and understand that the treatment is provided for relaxation, wellness and relief of muscular tension.

2. Medical Disclaimer *

By clicking here, I understand that massage and spa treatments are not a substitute for medical examination, diagnosis or treatment, and that therapists do not diagnose medical conditions, prescribe medication or provide medical treatment.

3. Health Information Declaration *

By clicking here, I confirm that I have disclosed any relevant allergies, sensitivities, injuries or health concerns that may affect the safety or suitability of my treatment.

4. Allergies & Reactions *

By clicking here, I understand that spa treatments may involve oils, creams, fragrances, essential oils and skincare products, and that allergic reactions or sensitivities may occur. I agree to inform my therapist of any known allergies or sensitivities before treatment.

5. Undisclosed Information *

By clicking here, I understand that Hartbeespoort Country Hotel & Spa cannot reasonably be held responsible for an injury, allergic reaction, sensitivity or adverse outcome resulting from relevant information that I failed to disclose, except where liability cannot legally be excluded.

6. Pain or Discomfort *

By clicking here, I agree to immediately inform my therapist if I experience pain, discomfort, burning, irritation, dizziness or any unusual reaction so that the treatment, pressure or technique can be adjusted or stopped.

7. Therapist’s Right to Stop Treatment *

By clicking here, I understand that the therapist may modify, postpone, refuse or discontinue treatment if, in their professional judgment, the treatment is unsafe, contraindicated or unsuitable for me.

8. Professional Conduct *

By clicking here, I understand that inappropriate, abusive, threatening, illegal or sexually suggestive behaviour, remarks, gestures or advances may result in the immediate termination of the treatment and refusal of future services

9. Treatment Risks *

By clicking here, I acknowledge that individual reactions to massage and spa treatments may differ and that temporary tenderness, redness, sensitivity, discomfort or other minor reactions may occur depending on the treatment received.

10. Safety Instructions *

By clicking here, I agree to follow all reasonable safety instructions, rules and treatment guidelines communicated to me by Hartbeespoort Country Hotel & Spa and its therapists.

11. Liability & Indemnity *

By clicking here, I voluntarily participate in spa treatments and acknowledge the ordinary risks associated with such treatments. To the fullest extent permitted by law, I agree not to hold Hartbeespoort Country Hotel & Spa, its owners, management, employees or therapists responsible for loss, injury or adverse outcomes arising from my participation, except where liability cannot legally be excluded.

12. Accuracy of Information *

By clicking here, I confirm that all information I have provided on this form is true, complete and accurate to the best of my knowledge.

13. Terms & Conditions *

By clicking here, I confirm that I have read, understood and agree to the Terms and Conditions of Hartbeespoort Country Hotel & Spa.

14. Privacy Consent *

By clicking here, I consent to Hartbeespoort Country Hotel & Spa collecting and using the personal information provided in this form only where reasonably necessary for my treatment, safety, booking and administration.

15. Marketing Consent *

By clicking here, I consent to receiving marketing and promotional communications from Hartbeespoort Country Hotel & Spa, including special offers, packages, events and updates. I understand that I may opt out at any time.

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Relax, Restore,Reconnect.

Relax, Unwind & Let Us Take Care of You

Please complete the consent form before your treatment.

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Custumber Care

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Plot 193 Old Rustenburg Road, Zandfontein, Hartbeespoort