Facial Intake Form

Facial Intake Form

Facial Intake form for spa. Form Preview
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Intake Form
Massage or Skincare
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    Dat of Birth
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    • Yes
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    Clear
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    By SUBMITTING THIS FORM, you agree to the following:
    1) I give my permission to receive massage, facials or waxing services.
    2) I understand that therapeutic massage is not a substitute for traditional medical
    treatment or medications.
    3) I understand that the therapist or esthetician does not diagnose illnesses or injuries,
    or prescribe medications.
    4) I have clearance from my physician to receive facials and massage therapy.
    5) I understand the risks associated with massage therapy, facials, and waxing include, but are not limited to:
    • Superficial bruising or redness
    • Short-term muscle soreness
    • Exacerbation of undiscovered injury

    I, therefore, release Blomkraft and the individual therapist or esthetician from all liability concerning these injuries that may occur during the massage session.
    6) I understand the importance of informing my therapist of all medical
    conditions and medications I am taking, and to let the massage therapist know
    about any changes to these. I understand that there may be additional risks
    based on my physical condition.
    7) I understand that it is my responsibility to inform my therapist or esthetician of any
    discomfort I may feel during the session so he/she may adjust
    accordingly.
    8) I understand that I or the therapist may terminate the session at any
    time.
    9) I have been given a chance to ask questions about the session
    and my questions have been answered.

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    Because your service is by appointment only, your appointment is time reserved exclusively for you and we request that you please review our cancellation policy.
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