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Facial Intake Form

Facial Intake Form

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    • Yes Massage
    • No Massage
    • Yes Facial
    • No Facial
    • No Both
    • Yes Both
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    By SUBMITTING THIS FORM, you agree to the following:
    1) I give my permission to receive massage, facials or waxing services.
    2) I understand that therapeutic massage is not a substitute for traditional medical
    treatment or medications.
    3) I understand that esthetician does not diagnose illnesses or injuries,
    or prescribe medications.
    4) I have clearance from my physician to receive facials and massage therapy.
    5) 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, therefore, release  Epi Skin Spa, LLC and the esthetician from all liability concerning these injuries that may occur during the session.
    6) 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.
    7) I understand that it is my responsibility to inform my esthetician of any
    discomfort I may feel during the session so he/she may adjust
    accordingly.
    8) I understand that I or the therapist may terminate the session at any
    time.
    9) I have been given a chance to ask questions about the session
    and my questions have been answered.

     

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    Because Epi Skin Spa is by appointment only, your appointment is time reserved exclusively for you and we request that you please review our cancellation policy. 24 hour notice is required to cancel an appointment. Less than 24 hours a $50 charge is incurred. A no-call/no show will result in a 50% charge of the service booked. 
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