• New Client Intake

    AQUA Aesthetics
  • Today's Date*
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    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Can you receive texts?*
  • Format: (000) 000-0000.
  • I consent to email and phone communications related to post-procedure care and follow-ups and scheduling from Aesthetic Body Design LLC dba Aqua Aesthetics:*
  • By checking this box you agree to receive recurring text messages from Aesthetic Body Design LLC dba Aqua Aesthetics, Reply STOP to Opt out. Reply HELP for help. Message frequency varies. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages.*
  • I would like to receive communication about promotions and specials from Aesthetic Body Design LLC dba Aqua Aesthetics:*
  • What types of services are you interested in discussing at your consultation?*
  • I understand that treatments purchased through Groupons or other third-party platforms are considered promotional and may represent only a portion of what is needed to achieve my desired results. In the event that additional treatments are needed, what investment range fits your budget?*
  • Would you like to learn about AQUA memberships, VIP perks, and earning Repeat Cash toward treatments and skincare?*
  • Did you know we offer a Senior Discount (55+) and a Veteran Discount?*
  • Date*
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  • Office Policies

    Aqua Aesthetics
  • Consent to Maintain Beauty and Health Records & Privacy Acknowledgment

    AQUA Aesthetics
  • Aesthetic Body Design LLC dba Aqua Aesthetics collects and securely maintains your contact information, health history, treatment notes, and clinical photographs to provide safe, appropriate care, process payments, and manage practice operations.

    Access is limited to authorized personnel and service providers as needed. Information may be used or disclosed as permitted or required by applicable privacy laws. Other disclosures requiring your authorization, including use of your photographs for advertising or social media, require separate written permission.

    We may contact you about appointments and care. Marketing communications are subject to separate consent where required.

    Records, including clinical photographs, are retained according to applicable legal and professional requirements.

    You may request access to or copies of your records, corrections, confidential communications, restrictions on certain uses or disclosures, and an accounting of certain disclosures, subject to applicable law. You may raise privacy concerns with our office or file a complaint with the appropriate regulatory agency without retaliation.

    Acknowledgment and Consent

    I consent to Aqua Aesthetics maintaining my health history, treatment records, and clinical photographs for the purposes described above. I acknowledge that I have received or been offered a copy of Aqua Aesthetics’ Notice of Privacy Practices and may request a copy at any time. 

  • Date*
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    2 digit month, 2 digit day, 4 digit year
  • Purchase + Fee Policy

    AQUA Aesthetics
  • THE CLIENT AGREES THAT THIS PURCHASE MAY NOT BE CANCELLED, NOR IT IS REFUNDABLE. ALL COSTS ARE TO BE PAID PRIOR TO SCHEDULING. I understand these purchases are for goods and services sought out by my own choice, at Aesthetic Body Design LLC dba Aqua Aesthetics's permanent place of business, and they are not a membership program. Therefore, I understand they are non-refundable. In the event payment is made with a credit card and client elects to cancel the transaction or dispute the charge for services, Client understands and agrees a lawsuit will be filed in Washington County Circuit Court seeking costs, attorney fees and expenses, under ORS 20.082, and requesting damages for breach of contract.

    NOTE: These purchases are for goods and services - not a membership, therefore they are non-refundable.

    Treatments/services must be used wthin 1 year of purchase date.

    Purchase maybe gifted to someone else for use or the amount can be applied towards alternative services/products, but the client agrees this purchase amount may not be cancelled or is it refundable.

    Client agrees to pay Aesthetic Body Design LLC dba Aqua Aesthetics according to the prices and payment terms decided as indicated above.

    Debt Collection: Client understands if they cancel these payments, it does not relieve them of the responsibility of paying their account in full and that they are responsible to make other arrangements for payment. Client understands and agrees that if any payment is in default (missed payments), the outstanding balance of this agreement is payable in full immediately to Aesthetic Body Design LLC dba Aqua Aesthetics or they will use a third party to collect in full.  All fees associated with utilizing a collection agency will be the responsiblity of the client. 

    We reserve the right to transfer your data to a third-party debt collection agency. This data will be utilised solely for the recovery of any outstanding payment owed to the service provider.  

    Where a payment is due by more than 30 days and we refer the debt to our lawyers or a third party, a debt collection administration charge may apply.

    We do not guarantee results: Client agrees that these are aesthetic treatments, and by their very nature subjective and affected by the client's lifestyle, which is beyond Aesthetic Body Design LLC dba Aqua Aesthetics's control. Client understands Aesthetic Body Design LLC dba Aqua Aesthetics does not guarantee results. Client understands that interrupting the recommended treatment schedule will mitigate the end result, as well as not adhering to the recommended pre-care or post-care. Client understands results may vary and they may not achieve desired results if they do less than the recommended amount of treatments. Client also understands adverse effects may occur if proper before and aftercare protocols are not followed.

    Appointment Policy: Client agrees that treatments rooms, equipment and staff are solely assigned to their treatment appointment and that any no-shows forfeit their appointment, or without a minimum of 24 hours notice, will be assessed a cancellation fee of $100.00 debited to their account, which must be paid in full before their next treatment can be scheduled.

    Client agrees that all complementary, voucher and upgraded treatments are added at the end of the contractual treatments and, as such, have no refundable value.

  • Date*
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  • Appointment Policies

    AQUA Aesthetics
  • Appointment Policies

    At AQUA Aesthetics, we reserve your appointment time exclusively for you. Please review the following policies before booking.

    Cancellations & Rescheduling

    Please provide at least 24 hours’ notice to cancel or reschedule. Changes made with less than 24 hours’ notice are subject to:

    Appointments up to 60 minutes: $100 fee
    Appointments longer than 60 minutes: $200 fee
    Fees must be paid before your next appointment.

    No-Shows & Last-Minute Cancellations

    Appointments canceled within 2 hours of the start time, or missed without notice, are considered forfeited and cannot be rescheduled.

    For new-client consultations booked with Groupon or another prepaid voucher or package, a late cancellation or no-show will result in the voucher being redeemed or one prepaid session being forfeited.

    Children, Guests & Pets

    For safety, children under 12 and pets cannot be accommodated. Service animals are welcome. Guests and children ages 12 and older who are not receiving treatment must remain in the lobby.

    Practitioner Assignments

    Practitioners are assigned based on appointment availability. We cannot accommodate requests for specific staff members.

    Thank you for respecting our team’s time and helping us keep appointments running on schedule.

    Acknowledgment

    I have read and agree to AQUA Aesthetics’ appointment policies, including applicable fees and forfeiture of prepaid sessions.

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  • Photo Release for Marketing

    AQUA Aesthetics
  • I authorize Aesthetic Body Design LLC dba Aqua Aesthetics to use my photographs and videos, including before-and-after images, for advertising, education, and promotional purposes on its website, social media, and printed or digital materials.

    I understand these images may identify me and, once published, may be copied or shared by others. I permit reasonable editing that does not misrepresent my treatment or results. I waive prior approval of the finished materials and any right to payment or royalties.

    This permission remains effective until I revoke it in writing. Revocation will not affect uses already made or materials already distributed.

  • Agreement Choice:*
  • Date*
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