Vijayanagaram, Anbu Nagar, Santhoshapuram, Chennai

Srihouse Luna Wellness Studio logo Srihouse LunaWellness Studio

Client registration & consultation form

Welcome to Srihouse Luna Wellness Studio. Please complete this form so we can understand your needs and plan personalised care for you.

  • Takes about 5 minutes
  • Kept strictly confidential
  • We call you back to confirm a time
Part 1 of 5 Personal details

So we know who we are speaking with and how to reach you.

Gender

For example: Medavakkam, Velachery, Tambaram

How did you find Srihouse Luna Wellness Studio?
Part 2 of 5 Your consultation requirements

Tell us what you would like help with. Pick everything that applies.

What is the main reason for visiting us?
How long have you been experiencing this concern?
Have you received any treatment for this concern previously?
What is your primary expectation from our clinic?
Part 3 of 5 Health & wellness information

This helps us choose treatments that are safe and suitable for you.

Do you have any existing medical conditions?
Are you currently taking any medications?
Do you have any known allergies?
Are you pregnant or breastfeeding, where applicable?
Have you undergone any recent surgery or medical procedure?
Part 4 of 5 Your experience & feedback

For clients who have already visited us. New clients can skip this step.

Have you visited Srihouse Luna Wellness Studio before?
How would you rate your overall experience?
How satisfied are you with our service?
How would you rate our clinic ambience and cleanliness?
How satisfied are you with the staff's behaviour and communication?
Were the treatment details and procedures explained clearly?
Did you feel comfortable during your visit?
Would you recommend our clinic to your friends or family?
Would you like to visit us again?
Part 5 of 5 Consent & communication

Almost done. Please confirm the statements below.

I would like to receive updates about offers, services and wellness programmes through WhatsApp.
I agree to be contacted for appointment follow-ups and service feedback.

By submitting, you agree to our privacy policy. Fields marked * are required.