Simply Skin Las Vegas
Package Purchase Form
Name
*
Client's First Name
Last Name
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Treatment Type:
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Dermaplane
DiamondGlow
e-Two
eMatrix
Laser Facial – GMAXPro
Laser Facial – PicoWay
Laser Hair Removal
Microneedling
Sublime
Tattoo Removal
UltraClear
UltraShape Power
VelaShape III
BFP - LHR - Buy 7, Get 3
BFP - Tatt - Buy 4, Get 2
Treatment Area(s)/Description:
*
Price/Session
*
Number of Paid Sessions:
*
Number of Complimentary Sessions:
*
Total Sessions
*
Total Paid Today
Please be advised that you are purchasing a package and the following applies:
Packages are non-transferable in any way
*
INITIALS
Packages cannot be cannot be changed to a different treatment type
*
INITIALS
Packages cannot be assigned to a different body part/treatment area
*
INITIALS
Packages are client specific. They are YOUR packages and CANNOT be reassigned to anyone else regardless of the relationship
*
INITIALS
Packages are not refundable for any reason
*
INITIALS
Client's Name
*
Client Signature
*
Witness Name
*
Witness Signature
*
Submit
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