ESSpa Guest Spa Service Consent Form
By submitting this form, you acknowledge the truthful answers to the questions below in order to have hair, skin, nail or body services delivered at ESSpa Organic Hungarian Skincare + Salon.
Please enter a valid phone number.
By checking the boxes, you confirm that the following statements are true:
I agree to follow all ESSpa rules and protocols (written and/or verbal) during my visit/appointment in order to minimize the spread of viruses.
I have NOT traveled to India, Asia or South America in the last 30 days.
I understand the risk of unintentional exposure to virus while visiting ESSpa.
Do you have any of these symptoms? (check all that apply):
Fever (above 100.1)
Loss of Taste and/or Smell.
Shortness of Breath..
Unusual or extreme tiredness.
I will not enter ESSpa (spa or salon) for any reason if I am sick. I understand and agree that it is my responsibility to inform ESSpa staff if I am sick for any reason.
Do you have any issue(s) - medical or otherwise - that we should be aware of that might impact your visit to ESSpa?
If "Yes" above please explain
Are you currently taking Retin A or using any type of retinol product or any other prescription medication?
If "Yes" above please tell us what type of medication you are currently taking.
Please Check Box and then Sign Below:
I Understand that any services I receive at ESSpa are provided for the basic purposes of relaxation and that ESSpa Service(s) should not be inferred and/or construed as a substitute for medical examination, diagnosis, or treatment and nothing said in the course of my appointment should be considered as such. I agree that I have clearly provided all my known medical conditions and answered all questions honestly and I agree to inform my ESSpa Service Provider of any changes in my medical status. By signing below, I confirm that all the personal statements in this form are true and valid and willingly provided by me without coercion. I agree to pay in full for any and all appointment(s) scheduled by/for me on the date of service. If I do not show for a scheduled appointment(s) without giving 24 hours notice, I agree to still pay for the service(s). I will abide by all ESSpa rules and protocols (posted or otherwise) and I hereby indemnify and release ESSpa, its owners and employees from any and all liability from unintentional exposure or harm due to Covid19 or any other virus or illness. I agree, to the best of my knowledge, to give an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently ingesting or using topically. I have read and fully understand this agreement and all information detailed above. I understand the procedure and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I will not hold my Esthetician, Eva or ESSpa, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.
Parent/Guardian Name (if applicable)
Should be Empty: