Guest Intake Form

Masks Required: Per the State of Virginia guidelines service providers as well as clients must wear a face covering or mask at all times during the service time.

Illness Symptoms: Please notify us if you have any symptoms of illness including but not limited to fever, cough, sore throat, runny nose, loss of smell or taste, etc. 

I knowingly and willingly consent to have specific services during the COVID-19 pandemic and will not hold anyone or Natural Elements Spa & Salon liable for the possibility of contracting COVID-19.

I confirm that I am not presenting any of the following symptoms of COVID-19 listed below:

• Fever - temperature of 100 degrees fahrenheit or higher
• Shortness of breath
• Loss of sense of taste or smell
• Dry cough
• Runny Nose
• Sore throat

I verify that I have not traveled outsite of the United States in the past 14 days to countries that have been affected by COVID-19.

I verify that I have not traveled within the United States by commercial airline, bus, or train within the last 14 days.

I, the client, understand that massages, bodywork and facials I receive are provided for the basic purpose of relaxation and relief of muscular tension.  If I experience any pain or discomfort during the session, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort.  I further understand that massage or bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor or other qualified medical specialist for any mental or physical ailment that I am aware of.   I understand that practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such.  Because massages, bodywork, or facials should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner’s part should I fail to do so.  I also understand that any illicit or sexually suggestive remarks or advances made by me are considered sexual harassment and will result in the immediate termination of the session, and I will be liable for payment of the scheduled appointment; additionally, any similar remarks or advances made by a spa employee will result in termination of the session by me immediately and will be reported to the Spa Manager immediately. By signing below, I further agree that I will not hold Natural Elements Spa & Academy, Inc. Spa affiliates, or any of the employees responsible should there be any unfavorable outcome or result.

Cancellation Policy and Return Check Fee:

Our certified spa & salon professionals take extra special time and care in preparing for your appointment. Please respect our time as we respect yours. If you cannot make your appointment, we require 24-hour notice for all cancellations. For this reason, credit card or gift certificate is required to book an appointment. A $15.00 rebooking fee or a charge of 100% of the service will be applied to any appointments cancelled without 24 hours’ notice. If rebooking at the time of cancellation you will be charged a $15.00 rebooking fee only.  No-show appointments will be charged 100% of the service.  Gift Certificates will automatically be charged according to the above guidelines. Return Check Fee is $35.00. If you are late for your appointment, we will not be able to accommodate your full session time due to other clients following appointments. The Full value of the treatment will be charged.