NEW CLIENT FORM

NEW CLIENT INFORMATION

( Please note: this form is for New Clients with an existing appointment. If you do not have an appointment, please do not submit this form.)

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Client Phone Number*

Area CodePhone Number

E-mail*

Date of Birth*

MonthDayYear

Occupation

*Please read the following statements carefully and indicate your understanding and acceptance by signing below, electronically.

A. CANCELLATION POLICY

We require 24 hour advance notice in order to cancel or reschedule any service with no charge. If your appointment is not cancelled within this notification period, your appointment is considered confirmed. Any appointment cancelled, or changed without 24 hour notice will result in a charge equal to 50% of the reserved service amount. “NO SHOWS” will be charged 100% of the reserved service amount. The policy applies to members and non-members alike. The appointment may be taken off of a membership or charged individually. Because of this policy, a valid credit card number is required at time of booking. This policy also applies to gift card and certificate holders. We understand that certain circumstances may prevent you from being able to make your appointment and will do our best to work with you in that situation.

B. LIABILITY

I will let my Esthetician/Skin Therapist know if anything changes between appointments that could affect my service, (such as new medications, new topical creams & exfoliation, surgeries, botox/fillers, etc.).
I will follow all written and oral aftercare instructions given by my Esthetician/Skin Therapist to ensure I obtain the best results on each service I receive.

C. WAIVER, RELEASE, ASSUMPTION OF RISK

While Skin Facial Bar, LLC and its staff take reasonable precautions to minimize the likelihood of any personal injury resulting from the provision of skincare treatment services, there is inherent risk involved in the delivery and receipt of skincare treatment services, which risk cannot be completely eliminated. By signing below, I acknowledge the existence of this risk, and I agree to accept and assume this risk. I further acknowledge that it is my responsibility to ask questions about the services, to disclose all known allergies and medical conditions to the service provider, and to make an informed decision regarding the receipt of services, all prior to receipt of any services.

TO THE MAXIMUM EXTENT ALLOWABLE BY LAW, I HEREBY WAIVE MY RIGHT TO PURSUE ANY CLAIM, ACTION, OR DEMAND AGAINST SKIN FACIAL BAR, LLC, ITS EMPLOYEES, AND ITS STAFF, RELATING IN ANY MANNER TO THE RECEIPT OF SKINCARE TREATMENT SERVICES. I FURTHER RELEASE SKIN FACIAL BAR, LLC, ITS EMPLOYEES, AND ITS STAFF FROM ANY AND ALL LIABILITY FOR CLAIMS RELATING TO MY RECEIPT OF SKINCARE TREATMENT SERVICES. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, LOSSES WHICH MAY OCCUR AS A RESULT OF: ALLERGIC REACTIONS; SKIN IRRITATION OR DRYNESS; POST-TREATMENT AILMENTS; AND EQUIPMENT MALFUNCTION.

By signing below, I agree to the cancellation policy and waiver/release described above. I am aware there are no refunds on any service or product. I agree that this document 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 from treatments received. (If client is under 18 years old, parent/guardian must sign below.)

Signature*

Date*

Skin Facial Bar LLC | 8300 Old Courthouse Rd. Suite #240, Vienna, VA 22182 | 703-827-3777