• Facial form

  • Format: (000) 000-0000.
  • Medical history: do you have or have you had any of the following conditions? If yes please check all that apply.*
  • Have you ever had a skin analysis?*
  • Do you wear sunscreen on a regular basis?*
  • Do you regularly visit tanning booths?*
  • Do you smoke?*
  • Are you pregnant and/or nursing?*
  • Do you wear contact lenses?*
  • Do you currently or have you used in the last year any acne medication (Accutane) or topical creams?*
  • Are you currently under the care of the dermatologist?*
  • Are you currently or have you recently had any of these treatments done? (If you have had any of these treatments done in the last three months please mark it)*

  • Consent agreement

  • I affirm that I have stated all my known medical conditions and answered all questions honestly. I agreed to keep the provider updated as to any changes in my medical profile for any future treatment if needed, and understand that there shall be no liability to the esthetcian performing the treatment or the business (The Face Space by Alyssa LLC) should I fail to do so. 

    I understand and accept any risks during and after my treatment. I hearby release Alyssa Skene and The Face Space Esthetics from all liabilities associated with all facial treatments done by Alyssa Skene.

    I agree that this consent supersedes any previous verbal or written disclosure. This consent is valid for all my facial treatment in the future as well.

    I hear by consent Alyssa Skene or the bussiness (The Face Space by Alyssa LLC) to take photographs of the undersigned both before and after any procedures being undertaken by Alyssa Skene or the bussiness (The Face Space by Alyssa LLC) at the request of the undersigned. I understand these will be used to show others the results of these treatments, for promotional purposes, and for Alyssa Skene's business portfolio use. 

  • Date*
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  • Policy agreement

  • Our goal is to provide quality care in a timely manner. In order to do so we have had to implement an appointment/cancellation policy.

    Appointments are in high demand, and your early cancellation will give another person the opportunity to have access to a desired appointment time. This policy enables us to better utilize available appointments for our guests.

    We allow a 5 minute grace period, after 5 minutes there will be a $7 up-charge as a late fee. A late cancellation within 24hr period, you will be required to pay a non-refundable fee of 50% of the price of your initial service(s) cancelled. I understand life happens and things come up but as a small business owner it can be difficult to fill spots on such short notice. There may be some exceptions to this, but will be at discretion of The Face Space. Please attempt to inform your provider within before the 48hr mark to attempt to fill you previous appointment time. 

    Last minute rescheduling within a 24hr period may be accomodated within in the same work week, meaning monday-sunday of the current week, with a 50% fee the for the price of the scheduled service(s), this is a nonrefundable and nontransferable. This can be applied to your moved appointment but will be foregone if another cancelation or reschedule occurs and cannot be applied to appointments outside of the current work week. If you must move your appointment outside of the current week there Is a 100% non refundable and nontransferable charge for the price of the initial service(s) that were booked. This will not be applied to any future appointments. 

    If you arrive more than 10 minutes late for your appointment it is considered a no-show and  you will be charged 90% service fee for missed appointment. If you can be accommodated after the 10-15 minute mark there will be a $15 upcharge on your appointment time, as a late convenience fee. No call no show at time of appointment and less than 24 hours notice before scheduled appointment time will result in 100% non- refundable charge for the services missed.

    Accepted payment method is currently CASH ONLY. Card may be used as backup if stoping beforehand will cause you to be late to your appointment..

    CASH Disclaimer** I often have cash on hand to break bills but It Is never guaranteed, please come to your appointments with exact change, Any extra bills that cannot be broken will not be applied to future services.

    I am happy to answer any questions regarding this cancellation policy. I try to remain as flexible as I can be, so please keep open communication with me leading up to your appointment.

    By signing and dating below you agree to have read and fully understand the above Appointment Cancellation Policy and agree to be bound by it's terms. I agree to pay the cancellation fee in the event of a missed appointment.

  • Date*
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  • Should be Empty: