About this template
This vaginal steam intake form template helps holistic health practitioners, wellness centers, and specialized spas streamline client onboarding. Designed to collect crucial health background, contraindications, and treatment preferences, this digital form ensures sessions are safe and tailored to each individual's needs. Practitioners can easily review sensitivity indicators, birth control considerations, and herb preferences before every session.
Built for seamless digital collection, this template replaces messy paper forms with an organized Google Form. Clients can securely submit their health history, allergies, and pre-session questions from any device. With Doc2Form, you can instantly turn this structured layout into a ready-to-use Google Form in seconds, saving administrative time and elevating your client care experience.
Key features
- Collect complete health history and contraindications before sessions
- Identify herb preferences including cleansing, cooling, and soothing blends
- Screen for food and plant allergies to ensure safe treatments
- Gather client signatures and pre-session questions in one place
- Access responses instantly on any device via Google Workspace
Use cases
Holistic wellness clinics onboarding new yoni steam clients
Spas and wellness centers managing herbal steam treatments
Independent practitioners tracking client treatment schedules and rec…
Independent practitioners tracking client treatment schedules and recommendations
What this form collects
- Practitioner Name (Short answer)Enter the name of the practitioner conducting your session.
- Practitioner Email (Short answer)Enter the email address of your practitioner.
- Client Full Name (Short answer)Enter your first and last name.
- Client Email Address (Short answer)Where should we send your session notes and follow-up recommendations?
- Session Date (Date)Select the date of your scheduled appointment.
- Contraindications Status (Multiple choice)Are you currently pregnant, menstruating, or experiencing open wounds or active infections?
- Birth Control & Infection Status (Checkboxes)Select any current conditions or birth control methods that apply to you.
- Sensitivity Indicators Status (Paragraph)Do you have any known skin sensitivities or localized tissue sensitivities?
- Herb Blend Preferences: Restore & Cleansing (Multiple choice)Indicate if you would like to include restore or cleansing herbs in your steam blend.
- Herb Blend Preferences: Align & Gentle (Multiple choice)Indicate if you prefer gentle or balancing herbal blends.
- Herb Blend Preferences: Detox & Disinfecting (Multiple choice)Indicate if you prefer detoxifying or disinfecting herbs.
- Herb Blend Preferences: Rebalance & Cooling (Multiple choice)Indicate if you prefer cooling or rebalancing herbs (ideal for excess heat).
- Food or Plant Allergies (Paragraph)List any known allergies to plants, herbs, essential oils, or foods.
- Excess Heat Indicators (Multiple choice)Do you experience symptoms of excess heat (e.g., hot flashes, night sweats, inflammation)?
- Pre-Session Questions or Hesitations (Paragraph)Share any questions or concerns you have before your treatment.
- Client Signature (Short answer)Please type your full legal name as your electronic signature confirming the accuracy of this information.
- Signature Date (Date)Today's date.
FAQ
How do I use this Vaginal Steam Intake Form?
Simply use Doc2Form to instantly convert this template into your own Google Form. Once generated, you can customize questions, adjust herb options, and share the link directly with your clients before their appointment.
What information does this form collect?
It gathers client contact details, medical history, contraindications, sensitivity indicators, herb blend preferences, allergy information, and digital acknowledgment or signatures.
Can I customize the herbal blend options?
Yes! Once the template is in your Google Workspace, you can easily add, remove, or edit any option to match the specific herbal blends and protocols your practice uses.
Is this form mobile-friendly for my clients?
Absolutely. Google Forms are fully responsive, meaning your clients can easily fill out and submit their intake forms from their smartphones, tablets, or computers.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.