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Which Cocoon Wellness/Medical spa are you now? *
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Legian, Bali
Ubud, Bali
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Amwaj, Bahrain
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MEDICAL HISTORY
MEDICATIONS ALLERGIES
COSMETIC ALLERGIES INGREDIENT
Aloe Vera
Sulphur
Benzoyl Peroxide
Hydroquinone
Progesterone
Glycolic
Cortisone
Vit C Topical
Vit E Topical
Sunscreen
Retin A/Retinol
List All Prescription and Over the Counter Medications You are Currently Taking (Including Asprin, Ibuprofen, Herbs & Vitamin):
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What is Your Treatment Plan for today? *
Facial
Wellness
(Colon, Vitamin IV and Sauna)
Massage
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Massage Questionnaire
What presssure do you prefer?
Light
Medium
Deep
Are ther any areas (feet, face, abdomen, etc. ) You do not want massaged?
No
Yes
Are there any areas that you do want us to focus on?
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Yes
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