By submitting this form, you agree to the following:
- I give my permission to receive massage, facials or waxing services.
- I understand that therapeutic massage is not a substitute for traditional medical
treatment or medications.
- I understand that the esthetician does not diagnose illnesses or injuries, or prescribe medications.
- I have clearance from my physician to receive facials and massage therapy.
- I understand the risks associated with massage therapy, facials, and waxing include, but are not limited to:
- Superficial bruising or redness
- Short-term muscle soreness
- Exacerbation of undiscovered injury
- I understand the importance of informing my therapist of all medical conditions and medications I am taking, and to let the esthetician know about any changes to these. I understand that there may be additional risks based on my physical condition.
- I understand that it is my responsibility to inform my therapist or esthetician of any
discomfort I may feel during the session so she may adjust accordingly.
- I understand that I or the therapist may terminate the session at any
time.
- I have been given a chance to ask questions about the session
and my questions have been answered.
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I am aware that it is my responsibility to inform the esthetician of my current medical or health conditions and to update this history. The treatments I receive here are voluntary and I release this institution and/or skin care professional from liability and assume full responsibility thereof.