• CLIENT INTAKE, WAIVER, RELEASE & CONSENT AGREEMENT

  • All informations provided are strictly confidential.

  • DOB:*
     - -
  •  -

  • The following information is essential to optimize the results of your service:

  • Have you ever had a facial in the past?*
  • Conditions you are currently experiencing today (Please select all that apply):*
  • Which aroma do you prefer:*
  • Are you currently taking any oral or topical prescription medication(s)?*
  • If yes to above, please check the prescription medication(s) that you are currently taking/using:
  • Do you have any allergies to ingredients, medications or foods?*
  • Are you pregnant or breastfeeding?*
  • Do you smoke?*
  • Any tattoos or permanent make-up?*
  • Do you wear sunscreen?*
  • Do you get cold sores?*
  • What is your skin type?*
  • Do you have a skincare regimen that you use daily?*
  • What areas of concern do you have regarding your skin? Please check all that apply.*

  • Please take a moment to carefully read the following list of conditions and check any that have affected your health either past or present:*

  • Have you undergone any of the following treatments? (Check all that apply)*

  • Have you been under the care of a Dermatologist within the past year?*

  • I hereby give my consent for my Aesthetician to take the necessary pictures to document my treatments and services.

    This agreement will remain in effect for the procedure and all future follow-ups conducted by Bliss Esthetics, LLC. I understand that this consent agreement is legal and binding. I have read and fully understand all information in this agreement.

  • I also give my consent to have my pictures posted on social media, printed materials, etc. for the purposes of marketing and education. I also understand that I may request copies of my pictures at any time.

  • Photo Consent*

  • Spa Policies

    Booking an Appointment

    In order to obtain your desired appointment, it is best to schedule in advance. A credit card is required to secure your appointment, A reminder will be sent thru text/email. Make sure to reply to confirm your appointment. Please make sure you arrive on time. Please text your esthetician upon arrival. No cell phone use in the spa. We ask that you turn your cell phone on silent during your services and take phone calls outside of the spa. We are a busy spa so please refrain from talking loud while in the spa.

    Cancellation/Rescheduling/No Show Policy

    Our spa treatments are reserved especially for you. We value your business and we ask that you respect the spa's scheduling policies. By booking an appointment, you are accepting the conditions of our cancellation policy. We ask that you reschedule or cancel at least 2 days before the beginning of your appointment or you may be charged a cancellation fee of 50% of the cost of your service. If you cancel or reschedule your appointment less than 24. hours, you will be charged 100% of the cost of your service. If we are not able to charge your card, it will be added to your next appointment.

    Late

    Arriving late will simply limit the time of your treatment, reducing its effectiveness and pleasure. Your treatment will end on time so that the next guest is not delayed. If you are more than 15 mins late, you will be considered a NO SHOW and will be charged for the full amount of your service. All other cancellation or rescheduling should be done online by logging into your Squareup account . Booked appointment may be adjusted or reschedule at anytime due to our availability or important events.

    Transaction Policy

    Contactless payment is offered at the spa. To limit contact, it is highly recommended that payment be contactless. I accept Debit, major Credit Cards and After Pay. If cash is preferred, please bring exact amount. I will not have cash change readily available during this time.

    Effectively immediately, all credit card transactions will be added a fee of 3% + Hawaii State Tax of 4.712%. We gladly appreciate your generous tips in cash.

    At any time during our contact with you, if we feel  you are not complying with the rules stated above, show signs of illness or are in any way combative, we reserve the right to refuse service and will ask you to leave immediately.

    By signng this waiver, you understand that by entering a business open to the public, you are susceptible to the risk of exposure to any illness including but not limited to the Corona Virus also known as COVID-19 and will not hold Bliss Esthetics, LLC liable for any symptoms of illness following your contact with us and will contact us if you do develop symptoms within 5 days after your visit.

    By signing below, you agree to comply with the written instructions above. Failure to comply with these written or verbal instructions from staff may result in your removal from the premises.

    Refund Policy:

    We do not warrant that the quality of any products, services, information or other material purchased or obtained by you will meet your expectations, or that any errors in the service will be corrected.

    ALL SALES ARE FINAL.

    Thank you & we appreciate your support!

  • What other treatments are you interested in? (Check all that apply)*

  • Please read and sign the Waiver Form:

    I fully understand and acknowledge that there are risks involved with such treatments, like Facial, Chemical Peel, Microdermabrasion, Microcurrent, Electrical Skin Treatments and Waxing.  I have had the opportunity to ask questions regarding these risks and other possible complications.  I understand any false or misleading information I have given may lead to undesired results and complications and hereby waive Bliss Esthetics, LLC and the Esthetician's liability if such results or complications occur.  I further understand my failure to follow post care instructions may also lead to undesired results, complications, or effects and hereby waive Bliss Esthetics, LLC and the Esthetician's liability if such results or complications occur. In consideration for Bliss Esthetics, LLC and the Esthetician performing this procedure, I agree I will assume the risk and full responsibility for any and all injuries, losses or damages, which might occur to me while I am undergoing this procedure or side effects I may experience after the procedure is performed.  I understand that the Esthetician does not diagnose illness, disease, or any other physical or mental conditions. Any sexual misconduct exhibited by the client will result in immediate termination of the session, and the client will be liable for payment of the scheduled appointment. To the maximum extent allowed by law, I agree to waive and release any and all present and future claims, suits or related causes of action against the Esthetician, Bliss Esthetics, LLC, its service providers, owners, officers, employees or agents of negligence, injury, loss, death, costs or other injuries or damages to me as a result of this procedure. I agree this waiver and release shall bind the members of my family and any spouse or domestic partnet, if I am alive, as well as my estate, family, heirs, administrators, or personal representatives if I am deceased, and shall be deemed as a "Release, Waiver, Discharge and Covenant" not to sue Bliss Esthetics, LLC or any of its service providers.

    By signing below, you agree to the following:

    I have completed this form to the best of my ability, acknowledge and agree to inform the Esthetician of any changes in the above information.  I have been informed and understand the contraindication to the requested treatments and agree that I do not have any condition(s) that would make the requested treatment unsuitable.  I will inform the Esthetician of any discomfort I may experience at any time during my treatment to allow them to adjust accordingly. I agree to waive all liabilities toward my Esthetician and the employer for any injury or damages incurred due to any misrepresentation of my health history.

  • Date*
     / /
  • Should be Empty: