Salt Cave Intake Form

Name*

Date of Birth*

Date

Address*

Phone*

Format: (000) 000-0000.

Email*

example@example.com

Emergency Contact Name*

Emergency Contact Number*

How did you hear about us

What is the name of the antibiotic

How often do you exercise

Please list any skin or health conditions you are experiencing

I am taking Retinol AI am taking AccutaneI am taking oral antibioticsI am taking topical antibiotics

What is your level of stress?

How many hours of sleep do you get per night

How many 8 OZ glasses of water do you drink a day

How many ounces of caffeine do you consume each day

YesNo

How much UV exposure do you get sun tanning beds commuting in car

Please list all supplements medications allergies or recent surgeries

Procedure Consent

Although we take every precaution to ensure your safety and well-being before, during and after your service please be aware of the possible risks below.

I understand that salt caves can have certain side effects such as redness, skin sensitivity, dry/itchythroat and increased coughing during and after treatment
I understand that the salt cave does not treat medical conditions nor does it claim or guarantee totreat or relieve any medical condition
I give permission to my therapist to perform the procedure we have discussed and will hold TheSweet Escape Spa harmless from any liability that may result from this treatment.
I have read and understand the risks involved with this treatment. I am willing to followrecommendations made by my esthetician for a home care regimen that can minimize or eliminatepossible negative reactions.
I understand that in the event I have questions or concerns regarding my treatment, I will consultThe Sweet Escape Spa immediately.

Please initial here to indicate your understanding and agreement of the risks above and that you consent for the treatment procedure*

Our time is very valuable. To ensure that we can provide all of our clients with excellent service, we ask that you be on time to all of your appointments. Please arrive at least 5 to 10 minutes prior to your scheduled time to ensure you receive your full appointment time.

In the event that you should be tardy, we ask that you be considerate and call to inform us of your situation SO we may take necessary action or make special arrangements. Please be aware that if you are 15 minutes or more late to your appointment, you will be voided. You will need to reschedule. NO EXCEPTIONS.

In the event that you need to cancel or reschedule your appointment, we asked that you notify us at least 48 hours in advance of your scheduled appointment.

WE RESERVE THE RIGHT: to charge 30% of the scheduled service price when cancelling or rescheduling less than 24 hours prior to your appointment.

WE RESERVE THE RIGHT: to charge 50% of the scheduled service(s) on No-Shows.

** ALL CLIENTS MUST HAVE A CREDIT CARD ON FILE PRIOR TO BOOKING AN APPOINTMENT FOR ANY SERVICE TO GUARANTEE YOUR APPOINTMENT

The satisfaction of our clients is our main priority. We offer prompt solutions to any problems or concerns that may occur We do not offer refunds, credits, or exchanges for products sold or services rendered.

If, for any reason, you feel dissatisfied with any of our services, please bring this to our attention. We appreciate all feedback, negative or positive, from our clients to better serve you. As part of our service we like to provide follow-ups in-person for any questions or concerns. / understand and acknowledge The Sweet Escape Spa's policy regarding lateness and appointment cancellations.

Signature*

Date*

Date

Signature of parent or guardian (if you are consenting to the treatment of a minor)

Date (if you are consenting to the treatment of a minor)

Date

Salt Cave Intake Form

Company Lateness and Cancellation Policy