Your Name (required)

Your Email (required)

Date (required)

Your Mobile Phone (required)

Where are you staying in Tulum? (required)

Date you are leaving? (required)

Are you pregnant? (required)
NoYes (If yes, How many weeks?)

Have you ever had a negative reaction to any skin care product and/or natural herb or essential oil?
NoYes (If yes, please describe)

Do you have any allergies?
NoYes (If yes, please describe your allergies)

Do you have any skin conditions or breakouts you are concerned about?
NoYes (If yes, please describe)

Do you have any of the following medical conditions? (required)
high/low blood pressurecontagious diseasespinal problemsheart problemsvaricose veinsarthritispacemakerdiabetescirculatory conditionjoint pain/inflammationphlebitisheadaches/dizzinessepilepsy/seizuresnursingasthmaclaustrophobiaarteriosclerosisfoot funguscancernone

In the last 7 days have you experience any of the following symptoms?
FeverCoughHeadacheDiarrheaVomitingChillsStomach painMuscular PainJoint painWeaknessRunny NoseSore ThroatConjunctivitisnone

Do you have any other diseases or medical conditions?
NoYes (If yes, please describe)

Have you had any medical or cosmetic procedures?
NoYes (Please describe with date?)

Have you had any recent surgeries or operations?
NoYes (Please describe, and when was your most recent procedure?)

Please list any additional comments regarding your skin care or general health

MASSAGE OR BODY THERAPY: Please mark with an X areas in need of attention.

Please mark the areas that you would like the therapist to avoid.

Please list any contraindication /indication

Because massage is contraindicated under certain conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree and understand that there shall be no liability on the therapist’s or Yaan Spa’s part should I neglect to do so.

By agreeing to receive services and sessions at Yäan Healing Sanctuary I release and forever discharge Yäan Healing Sanctuary, its employees and their associate Be Tulum & Nomade Hotel from any and all responsibility or liability arising from these procedures, sessions or advice, and from loss of property. I have not been promised anything to submit to these procedures or to sign this release and consent form. No guarantees or warranties have been made to me or the success, value or benefit of such procedures. I realize and acknowledge that any services received by me are not medical treatments or prescriptions.

I Further understand that the massage I receive is provided for the basic purpose of relaxation, stress reduction, and relief of muscular tension. I understand that the massage should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician or other qualified medical specialist for mental or physical ailment that I am aware of.

I understand, for my own health and safety, that entry to Yäan Healing Sanctuary can be denied if I arrive to my appointment under the influence of drugs or alcohol. Yäan reserves the right to decline a treatment to a guest if the therapist considers it inappropriate or contraindicated.

This form has been explained to me and I certify I understand its consents,


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