V-steam preference survey

Your preference

Thank you for booking our program!
We would like to know about your preference in our program as we want to customize it for you!
Please fill the questionnaire before your visit for your maximum benefit.
We look forward to seeing you.
1.Do you have any concerns about the program? e.g.your medical or psychological condition, departing time, getting the location, and so on.
2.Have you ever tried v-steam before?
3.Have you ever had any problem with complementary therapies including v-steam before?
4.Which course do you prefer?
5.Informed consent will be taken before the program. Please read below.
1.       I understand that the therapist does not diagnose illness, disease, or any further physical or mental disorders.
2.      I understand that this program is not a substitute for medical treatment or diagnoses and that it is recommended that I see a physician for any physical ailments that I may have.
3.       I don't have contraindications below;
 1)I am not pregnant.
 2)I am not on my period.
 3)I don't have an IUD
 4)I don't have excess heat in the body due to fever or hypersensitivity for heat.
 5)I don't have any type of internal or external infection.

4.      I acknowledge that the information I have provided on this form is correct and current to the best of my knowledge. I understand that it is my responsibility to inform the therapist of any changes to this information.
5.      I understand that if I experience any unusual discomfort and/or pain during the program sessions it is my responsibility to inform the therapist.

I read and understand the condition above and agreed.
6.Your name
7.Email address
8.Phone
9.Heigh/Weight
10.The location of salon Gem is
https://maps.app.goo.gl/D5Ly3Fpn8iYDad6x8

And this is the direction movie to Salon Gem.
https://youtu.be/1Hq-3Y2xI-o
https://goo.gl/maps/Ytu2qrUor2g7vnKAA
If you can get her salon directly with your car, please come. If the way is too complicated for you, you can wait at Family mart (It's currently covered with a gray sheet).

Do you think you can get the salon or do you want the therapist to get you at family mart?(Required.)