• Skin Deep Day Spa, LLC

    1212 Wildwood, Suite A & B, Jackson, MI  49202

    517.990.9088   -   skindeepspajackson.com

  • SERVICE INTAKE FORM

    General Information - Health History - Skin Care/Waxing - Massage
  • Please complete this form thoroughly and answer the questions honestly.

  • General Information

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  • SERVICE INTAKE FORM

    General Information - Health History - Skin Care/Waxing - Massage
  • Health History

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  • 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.


  • SERVICE INTAKE FORM

    General Information - Health History - Skin Care/Waxing - Massage
  • Skin Care/Waxing

  • PLEASE NOTE:

    WAXING - For us to provide any waxing service the hair must be 1/4 inch in length or longer.

    TANNING - We request you referain from tanning for 48 hours or more before your service. 

    ANTI-AGING/ACNE LIGHT THERAPY - Our Celluma device offers zero physical contact by low level light therapy for anti-aging &/or acne. However, 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. Also light therapy is not recommended for persons with epilepsy.

  • Post Facial Care/Waxing Instructions: Aerobic exercise and/or vigorous physical activity should be avoided for 24 hours. Direct sunlight exposure is to be avoided immediately following the treatment. A broad-spectrum sunscreen of SPF 30 should become part of your daily skin care regimen. Your skin can become more sensitive to sun in a result of this treatment. Unless otherwise specified, in the evening following your treatment, cleanse your skin with a mild cleanser and water followed by a non-active moisturizer. Do not apply additional exfoliating ingredients/products the day of your service as over-exfoliation can result in irritation or further sensitivity. Consult your Esthetician before resuming topical treatments. Facial treatments and waxing can result in skin flushing/redness or slight skin flaking or sensitivity for up to 48-72 hours post treatment. DO NOT peel, pick, rub, or scratch your skin at any time, whatsoever. This can potentially cause damage or compromise your results.

  • SERVICE INTAKE FORM

    General Information - Health History - Skin Care/Waxing - Massage
  • Massage

  • SERVICE INTAKE FORM

    General Information - Health History - Skin Care/Waxing - Massage
  • 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 or to COVID-19. I further hereby knowingly consent to receive treatment from Skin Deep Day Spa, LLC.

    Note: All prices are subject to change without prior notice. Skin Deep Day Spa LLC.

    I understand the following cancellation policy: Cancellation of appointments with less than a 24-hour notice are charged a cancellation fee of 50% of the missed service. Spa Packages and Spa Parties will need to give a 48 hour notice. The credit card on file is charged a fee of 100% of the missed service and will be required to place a nonrefundable deposit to schedule future appointments. Two no shows in a 12 month period will result in termination of our practice. 

     

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  • PHOTO RELEASE FORM

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  • I,          authorize Skin Deep Day Spa to take photographs of my face/treatment area. With the sole intent of encouragement to others that may be considering the same or similar procedures, your photos may be considered of such a good quality that we may choose them for the spa photo album, or social media advertisement to educate future clients, such as Instagram and/or Facebook. At no time will any personal information or name be given. These photographs may be used for client referrals and/or educational purposes.

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