Skin Deep Day Spa, LLC
1216 Wildwood, Suite C, Jackson, MI 49202
517.990.9088 - skindeepspajackson.com
Please complete this form thoroughly and answer the questions honestly.
Please Note: It is our policy that we do not offer any services to persons that are less than 12 weeks into their pregnancy. We request you set your appointment for a date after the initial 12 weeks of your pregnancy has passed.
If you are seeking corrective treatments please detail the SPECIFIC products (BRAND & PRODUCT TYPE/NAME) you are currently using so we can best answer any questions on ingredients and help you meet your skin care goals.
Our Celluma device offers zero physical contact by low level light therapy for anti-aging &/or acne. We can add the Celluma light therapy to your service upon request.
Please note: Depending on where the light therapy is needed, for example over the face for anti-aging, acne or for pain management, one who suffers from claustrophobia may wish to see the device prior to scheduling a service.
Epilepsy is contraindicated for LED light therapy. Please speak with your practitioner about options.
By signing this form, I hereby release, hold harmless, waive, discharge, and covenant not to sue Skin Deep Day Spa, LLC, its directors, oﬃcers, employees, volunteers, and agents with respect to any liability for any injury, loss, and/or damage (including, but not limited to, illness or death) that I may sustain related to services &/or treatments rendered. I further hereby knowingly consent to receive treatment from Skin Deep Day Spa, LLC