Intake & Consent Form

Client's Name

First NameLast Name

Gender

Date of Birth

Date

Phone Number

Format: (000) 000-0000.

Email Address

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

As the following may be contraindicative to your service, please acknowledge if the following may pertain to you:

If you have answered "Yes" to any of the answers above, please provide details.

Have you ever had a facial treatment before? If so, when was the last time?

What do you think your skin type is?

What skin care products are you currently using?

Are you a smoker?

Are you wearing any contact lenses?

What are your current skin care concerns and goals?

Have you ever experienced sound healing?

Photos may be taken during your service for the purpose of tracking progress and/or used for promotional and educational purposes. Do you consent to photos/videos of your treatment being shared online/social media?

I understand that my data will be strictly confidential. The Glowing Aura does not sell, share, or resell information. I confirm that all information in this form is true and accurate. I understand and voluntarily accept any risks and/or allergic reactions associated with the services, products, and equipment used. I confirm that if I withhold some important information and complications occur, The Glowing Aura will not be liable. I release this The Glowing Aura and hold harmless against any claims, expenses, damages, and liabilities.

Because facial services should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions honestly. I agree to keep my esthetician updated as to any changes of my skin or medical profile and understand that there shall be no liability on the esthetician's part should I fail to do so.

Please note that certain skin care treatments can have side effects such as immediate sunburn appearance, pinkness, rosey tone, tightness, peeling, flaking, swelling, tenderness, dryness or itchiness. Please also note that certain massage modalities may cause tenderness, soreness, or bruising.

I understand that sound healing is a form of complementary alternative medicine and it is a modality used to promote stress reduction & relaxation. Reiki & Sound Healer Practitioners do not diagnose conditions, prescribe substances, perform or interfere with medical treatment by a licensed physician.

DEPOSIT:
As we have reserved time and space in our schedules specially for you, we require a NON-REFUNDABLE $20 deposit when reserving your first appointment online. Your deposit will be credited toward the full price of your treatment scheduled. In the event of a cancellation less than 48 hours from your scheduled appointment time, your deposit will automatically be forfeited. A new deposit will be required to make a new appointment. Please see our full cancellation policy below.

TARDINESS:
We understand that sometimes being late is outside of your control. However, depending on circumstances, we may have to abbreviate or reschedule your appointment. If you arrive late, you will still be charged in full for the treatment scheduled, but may receive an abbreviated session.

CANCELLATIONS:
A 48 hour notice is kindly requested for cancellations and rescheduling. In the event of a less than 48 hour notice or no call/no show, we reserve the right to charge 50% of the scheduled treatment amount. Your initial deposit will be credited toward the cancellation fee. As per our cancellation policy, please note that your credit card information is collected and kept in a secure server when reserving your appointment. Your information is only ever accessed in the event of a no call no show.

If you need to cancel an appointment with less than 48 hour notice, your deposit will automatically be forfeited and an additional deposit will be required for a future appointment reservation.

In the event of a life emergency or sickness requiring you to cancel or reschedule within less than 48 hours notice, we will assess the situation with sensitivity as to whether or not the deposit will be forfeited or if a cancellation fee will be required. We have the right to deny services to those who do not respect the policies set in place.

We appreciate you for respecting our time and thank you for your understanding.

Client Signature

Date Signed

Date

Intake & Consent Form

Terms & Conditions