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.
In signing this form I acknowledge and testify as to the following;
All information I have given both written &/or verbally, is true to the best of my knowledge and it is my sole responsibility to inform &/or update Skin Deep Day Spa LLC as to any changes in my health status &/or personal information.
I, the client, as well as the attending practitioner have the right to stop or refuse any treatment or service at any time.
I understand, Skin Deep Day Spa LLC’s practitioners do not diagnose any illness or medical condition, nor will Skin Deep Day Spa LLC’s practitioners work outside guidelines as defined by the State of Michigan in Scope of Practice for the type of service offered at any time for any reason.
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