Membership Changes Form

Membership Changes Form

Freeze, change or cancel your membership
Member Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Best Phone Number To Reach You At*
Please enter a valid phone number.
Membership Type:*

Acne Program MembershipHealthy Skin Club
I am...*

Canceling before my 6 month TermCanceling after my 6 month TermUnsure where I am at in my TermHaving a temporary issue and I would like to freeze my account for ONE payment cycleI would like to transfer to a different membershipHaving a Temporary Issue and I would like to freeze my account for TWO payment cycles
YOUR MEMBERSHIP TERMS
Membership Freeze:

If you are traveling or needing to pause your services, your membership can be frozen for up to 60 days at Management discretion; benefits, other than accumulated prepaid services, are also frozen until you reinstate your membership.

Membership Cancellations:
- You Must Provide written notice at least 5 days before your NEXT billing date to ensure your Membership will terminate before your next payment; otherwise, you may be subject to an additional billing cycle and member dues before cancellation can occur.
- A Cancellation Form must be completed for our records.
- Need to Cancel after 6 month term is complete?
  - After 6 consecutive monthly Membership payments there is no fee to cancel your membership
- Early Termination Fees: If you request to cancel within your initial 6 month term a fee will apply.
  - The Healthy Skin Club Early Cancellation Fee is $99 and will be charged to the card or back up card on file with us at the time of your membership contract early cancellation.
  - Acne Program Membership Early Cancellation Fee is $149 and will be charged to the card or back up card on file with us at the time of your membership contract early cancellation.
- If your Membership is terminated early or prior to the end of your contract term, all accrued or unused services will be expired at the time of termination.
I agree to the above terms and conditions as they pertain to my membershipI have a sensitive situation I would like to be contacted aboutI would like to be contacted about other options available to me outside of cancelation
Reason for Canceling or Freezing*
Please upload any documents here if asked to do so by staff

Cancelof
Signature of Member/Guardian*

Clear
Best Time To Reach Out If Needed:
Please add 2 days/times you are available for phone calls if we need any additional information from you
Should be Empty: