Spa Party Facial Treatment

Thank you for taking the time to fill out this form for the upcoming spa party your attending. We’re looking forward to providing you with the ultimate spa experience.   All of the information provided is confidential and will only be shared with the spa party coordinator and the technician performing your service. Your privacy and safety is our utmost concern. Please feel to contact us if you have any questions. 

Facial Intake Form

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Medical History

  • Skin Care & Therapy

  • Policy & Consent

    Slight redness due to stimulation is normal following skincare treatments and should go away within a few hours at the most. If breakouts occur, it is more than likely due to trapped dirt and oil that is coming to the surface. If cared for properly, using a regular cleansing and moisturizing regimen with quality products recommended by a licensed esthetician or dermatologist, breakouts should disperse within a few days. If breakouts continue after a skincare treatment and proper home skincare regimen, you may be sensitive to the product being used. Consult the Synergy Skin Care Spa, LLC immediately if problems occur. Be sure to ask the technician if you have any questions or concerns related to the treatments or post-treatment care. Due to the high-risk nature of some medical conditions, it may be necessary to obtain a doctor’s release or permission before receiving treatment. I agree to inform the therapist of any experience of pain or concerns before, during and/or after the treatment. I further understand that services provided are NOT a substitution for a medical examination, diagnosis or treatment by a medical or chiropractic physician or other healthcare specialist.
  • I have read and fully understand the terms within the above policies and consent. All my questions have been addressed to my satisfaction. I certify that all of the above information is true and to the best of my knowledge. I understand and agree with the policies. By signing this form, I waive any and all claims, damages, action and liabilities against Synergy Skin Care & Spa arising out of or relating to massage therapy, hand/foot treatments, skincare and allergic reactions to services performed. In the event a dispute arises over the outcome of my procedure, I consent solely to arbitration as a legal means of settlement. I understand English, or if I do not, I have appointed someone to translate this consent form in its entirety. I am eighteen years of age (18) or older.
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.