New Client Consultation Form
  • Massage Consult & Consents

    *Please complete ASAP, Existing clients need only fill out 1X per year
  •  - -
  •  -

  • To Make Your Massage More Enjoyable

  • Tell Us About Yourself

  • Health History

    *Very important to determine eligibility of a service
  • GLO Beauty Bar, LLC CONSENTS

    1. I understand that any inappropriate behavior (verbal or physical) will result in immediate termination of the service, full payment, and possible notification of authorities. Zero tolerance policy.
    2. I confirm I have disclosed all relevant health conditions, allergies, physical limitations, and contraindications.
    3. I understand that, although rare, reactions or complications may occur and I will contact GLO and seek medical care if necessary.
    4. I understand I may communicate preferences, including pressure and areas to avoid, and may ask questions at any time.
    5. I agree to immediately inform my therapist of any discomfort so adjustments can be made or the service stopped.
    6. I understand this service is not a substitute for medical diagnosis or treatment.
    7. I acknowledge I have been informed of risks, contraindications, pre/post care, and expected outcomes, and choose to proceed with a LED light therapy massage (Swedish, Gua Sha, Muscle Scraping, Lymphatic Drainage or Hot Stone).
    8. I agree to all GLO Beauty Bar policies regarding scheduling, cancellations, no-shows, lateness, and illness.
    9. I consent to receive occasional email and/or text communications. Message/data rates may apply, and I may opt out at any time.
    10. I give permission to Victoria Buck, LMT, to perform my service(s) and release her from liability, acknowledging all precautions will be taken.
  • MEDIA CONSENT

  • I grant GLO Beauty Bar, LLC permission to capture and use my photo, video, and/or voice. I understand that all content is the property of GLO Beauty Bar, LLC and may be edited, published, and used for advertising, educational, and marketing purposes.

    I acknowledge that I will not receive compensation for such use and release GLO Beauty Bar, LLC from any claims related to the use of this content. I understand that once published, GLO Beauty Bar, LLC cannot control unauthorized use by third parties.

    I waive any right to inspect or approve the final use of these materials.

  • CLIENT SIGNATURE

  • By signing below, I confirm that I am over 18 years of age (or have parental consent), have read and fully understand all information provided, and have given a complete and accurate medical history. This disclosure supersedes any prior verbal or written statements.

    I consent to receive massage services and understand that, although rare, reactions or complications may occur. I acknowledge this is a legal and binding agreement and release my therapist from liability, as services are performed with proper training, care, and professional standards.

    I understand that results are not guaranteed and may vary based on individual factors and adherence to recommended care.

    I certify that I have had the opportunity to ask questions and will communicate any discomfort or concerns immediately during the service. This consent applies to all future treatments, and I agree to inform staff of any changes to my health or medical history.

  • Clear
  • Should be Empty: