Skin Deep Day Spa
1216 Wildwood Avenue, Ste. 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.
Breast feeding may increase skin sensativity & likelihood of PIH (post inflammatory hyperpigmentation).
Epilepsy is contraindicated for LED light therapy. Please speak with your practitioner about options.
Please note the following guidlines:
BOTOX: wait 5 - 7 days
FILLERS: wait 7 - 10 days
PEELS: wait 30 days
By selecting YES to any or each of the below questions &/or statements I am indicating that I fully understand the question &/or statement and I agree with an affirming YES to it’s accuracy as it pertains to me &/or my treatment.
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