Spa Consent Form
Spa Consent Form
Name
Date of Birth
Phone number
Emergency Contact's Name
Emergency Contact's Phone Number
Do you have any current medical conditions (e.g., heart disease, diabetes, skin disorders)? If yes, please specify:
Have you had any surgeries or medical treatments in the past 12 months? If yes, please describe:
Are you currently taking any medications (prescription or over-the-counter)? If yes, please list them:
Do you have any known allergies (e.g., to skincare products, medications, or environmental factors)? If yes, please detail:
Do you have any skin sensitivities or conditions (e.g., eczema, psoriasis, or recent sunburn)? If yes, please describe:
Description of the Treatments Being Provided
Potential Risks and Benefits
Contraindications (Conditions that may prevent treatment)
Consent to Treatment
I, the undersigned, acknowledge that I have been informed about the treatments I will receive, including their potential risks and benefits. I understand that it is my responsibility to provide accurate health information to ensure my safety during these treatments. By signing below, I give my consent to proceed with the specified spa services.
Liability Waiver
I acknowledge that the spa practitioners will take all necessary precautions to ensure my safety during treatments. However, I agree to release and hold harmless the spa, its employees, and agents from any liability for injuries or adverse reactions that may occur during or after the treatments. This waiver applies to all services provided and is effective immediately upon signing.
Confidentiality Statement
I understand that all personal and health information provided will be kept confidential and will only be used for the purpose of delivering safe and effective spa services. My information will not be shared with any third parties without my explicit consent, except as required by law. I acknowledge that I have read and understood this confidentiality statement.
Client's Name:
Date Signed:
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