GRS Client Intake

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Date

1) Have you been under the care of a physician, dermatologist or any other medical professional within the past year?

YESNO

Please Explain:

2) Have you undergone any recent surgeries or plastic surgery/aggressive medical treatments in the past year?

YESNO

Please Explain:

3) Are you currently taking and medications/herbal supplements/vitamins orally or topically? If YES, please list below. ( If you are currently using Retinol or Antibiotics please list frequency of use.)

4) Please list any known Allergies or any ingredients, scents (aromatherapy) that cause you discomfort.

5) Please list any pre- existing or current medical conditions that you have been diagnosed with.

6) Please list any current injuries that cause you discomfort?

7) Are you currently pregnant or trying to become pregnant or nursing?

8) Our therapeutic treatments include scalp massage, foot/leg and some ear massage reflexology. Please indicate if you feel uncomfortable with any of the above to ensure you have the most pleasant experience. Massage pressure preference?

9) We’re so happy you choose Green Revolution Studio! We’d love to know who referred you or how you heard about us!

10) We want to make sure you have a wonderful treatment experience with us here at GRS. Is there anything else you wish to share with us?

11) Do you prefer relaxation music paying during your treatment?

12) Are you open to a scalp massage treatment during your service?

About your Therapeutic Treatment at Green Revolution Studio

The customized treatments we provide include some peels and masks that are derived from natural sources yet still feel active on the skin. Our peels may contain lactic acid, AHA’s/BHA’s and Salicylic acids that may cause some peeling and irritation.During the treatment, extractions (the removal of white heads and black head congestion) may be performed which can occasionally bruise or irritate the skin if the skin is sensitized by oral or topical prescription creams or medications.Please inform us of any known pre existing medical conditions, allergies, topical and oral medication use such as-Retinol, Accutane, Antibiotics (or any chemically charged anti-aging or acne creams that may contraindicate facial or waxing treatments.)Bringing the above information to your skin therapist’s knowledge is extremely important to ensuring your comfort and safety.All client information listed and discussed during your treatment session with your skin therapist is kept confidential to honor your privacy.

Treatment Consent Agreement

I am permiting the liscenced esthetician working with me at Green Revolution Studio to perform waxing and facial services of my choice on me. I have read and fully understood this form carefully and answered all questions to the best of my knowledge. I clearly understand that the information provided for me about the services rendered.I agree to inform the therapist working with me at Green Revolution Skin Studio of any pre existing or current medical conditions and allergies to ensure my health and safety as well as the health and safety of my therapist.

CANCELLATION POLICY

By signing this form you have agreed to the terms of our cancellation policy.

There is a strict 48 hour cancellation and rescheduling policy as there can be a waitlist for our therapists and last min cancellations and reschedules are hard to rebook.

By booking your appointment, you are agreeing to this policy and your credit card on file will be charged.

We require a valid credit card on file for ALL first time appointments. Your personal information is secured and held confidential. Please notify us of a cancellations or changes to your scheduled appointment before 48 hours of your appointment to avoid charges.

All reservations cancelled 48 hours before your scheduled appointment time will be charged 50% of the service cost. We do charge a no-show, no-call fee which is 100% of the cost of services reserved.

We respect and value our client's time and business and we appreciate the same from our clients. Our scheduling system WILL NOT allow no-show clients to schedule any new appointments with us. All new and existing clients will receive a confirmation email and text reminder prior to each scheduled appointment, so please make sure to provide us with your most current and active contact information to avoid any miscommunication.

What if I’m running late to an appointment?

We value your business and strive to protect your service time as well as the time of others. We try to keep clients from delaying subsequent appointments, therefore, clients who arrive late to their appointment time will only receive the time remaining to respect others appointments as well as the therapist time. If you anticipate a late arrival, please notify us by messaging our square booking app or texting us at 301.656.2000.

Is there any chance you can waive my cancellation fee?

Because we are by appointment only and do not accept walk in clients, we are reserving the treatment room, products and the therapist’s time exclusively for you. 24 hour courtesy is much appreciated and is standard spa etiquette. We hope you will understand with warmest regards.

Name

First NameLast Name

Signature

GRS NEW CLIENT INTAKE