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  • New Client Intake Form

    Aesthetic Body Design
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  • Consent/Disclosure Form for Beauty + Health Records

    Aesthetic Body Design
  • At Aesthetic Body Design, we take your privacy seriously.

    For the safety of our clients, we maintain records of any health or medical conditions, which may indicate that a particular service or treatment should not go ahead (e.g. allergies, pregnancy, skin conditions) or particular products should not be used (e.g. products containing nuts, fish oils, aloe, etc We also maintain client photographs for internal use and client record keeping.

    These health records and photographs are not used for any other purpose.

    Client records are held securely within our spa software system and can only be seen by members of the Aesthetic Body Design team.

    I consent to you maintaining such records while I am a client. I understand photographs will be maintained for up to 1 year after the conclusion of my services with Aesthetic Body Design and other records such as treatment notes and medical history may be maintained for up to 3 years per Oregon Health Licensing regulation on maintaining client records.

    Office Policy

     Our office is dedicated to protect the privacy rights of our clients and the confidential information entrusted to us. The commitment of each employee to ensure that your health information is never compromised is a principle concept of our practice. We may, from time to time, amend our privacy policies and practices but will always inform you of any changes that might affect your rights.

    Protecting Your Personal HealthCare Information

    We use and disclose the information we collect from you only as allowed by the Health Insurance Probability and Accountability Act (HIPPA) and the state of Oregon. This personal health information will never be otherwise given to anyone, even family members, without your written consent. You, of course, may give written authorization for us to disclose your information to anyone you choose, for any purpose.

    Our offices and electronic systems are secure from unauthorized access and our employees are trained to make certain that the confidentiality of your records is always protected. Our privacy policy and practices apply to all former, current, and future clients, so you can be confident that your protected health information will never be improperly disclosed or released.

    Collecting Protected Health Information

    We will only request personal information needed to provide our standard of quality healthcare, implement payment activities, conduct normal healthcare practice operations, and comply with the law. This may include your name, address, telephone number(s), social security #, employment data, medical history, health records, etc.. While most of the information will be collected from you, we may obtain information from third parties if it is deemed necessary. Regardless of the source, your personal information will always be protected to the full extent of the law.

    Disclosure of your Protected Health Information

    As stated above, we may disclose information as required by law. We are obligated to provide information to law enforcement and governmental official under certain circumstances. We will not use your information for marketing purposes without your written consent.

    We may use and/or disclose your health information to communicate reminders about your appointments including voicemail/answering machine messages, postcards, newsletters and special events.

    Client Rights

    You have the right to request copies of your healthcare information; to request copies in various formats; and to request a list of instances in which we, or our business associates, have disclosed your protected information for use other than stated above. All such requests must be in writing. We may charge you for copies in an amount allowed by law. If you believe your rights have been violated, we urge you to notify us immediately. You can also notify the U.S. Department of Health and Human Services.

    We thank you for being a client at our office. Please let us know if you have any questions concerning your privacy rights and the protection of your personal health information.

    Link to the full HIPPA document: https://www.hhs.gov/hipaa/for-...

    I’ve been offered a copy of the full 7 page HIPPA document covering privacy rules that Aesthetic Body Design follows.

     

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  • Purchase + Fee Policy

    Aesthetic Body Design
  • 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'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 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 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's control. Client understands Aesthetic Body Design 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.

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  • Appointment Policies

    Aesthetic Body Design
  • General Booking Policy
    Friendly reminder, if you’d like to reschedule or cancel any appointments, we require 24-hour’s notice.  Any notice within that 24-hour period will require a rescheduling fee.  Please be advised you cannot be seen until the fee is paid in full.

    Reschedule Fees:

    • All cancellations with less than 24-hour’s notice for 15-60 minute appointments are subject to a $100 cancellation fee.
    • All cancellations with less than 24-hour’s notice for 60+ minute appointments are subject to a $200 cancellation fee.
    • No-show appointments (i.e. appointment time has commenced, and we have not heard from you) or appointments canceled 2 hours before the start time of an appointment, are considered forfeited and cannot be rescheduled.
    • Late cancellations or no-shows of new client consultations using Groupon, or any other coupon of pre-purchased services will have their coupon redeemed and one session of their pre-purchased series applied to the missed consultation and will count as a lost session.

    Children, Guests & Pet Policy

    Due to the clinic setting, we are not safely able to accommodate pets (besides working service animals) and children under the age of 12. Children 12 years+ and adult guests not receiving treatment are asked to wait in the lobby for the client receiving treatment.

    Your practitioner is assigned to you according to the appointment time you have requested. We book appointments according to availability and cannot accommodate requests for practitioners and staff members.

    Aesthetic Body Design and our staff pride ourselves on ensuring low-cost treatments nd that all of our patients are seen on time, without any unnecessary wait times typically experienced with other esthetic facilities. To accomplish this, we rely on our clients’ commitment to keeping the appointments they have scheduled for their convenience.

    To ensure you are seen promptly at your desired time, we strictly avoid any overbooking. 

    Aesthetic Body Design's pricing and specials are carefully calculated upon our clients’ abilities to keep the appointment times they have committed to.

    Please notify us 24-hours in advance if you cannot keep your appointment so we have the opportunity to schedule another client within your appointment time.

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  • Photo Release for Marketing

    Aesthetic Body Design
  • I hereby grant and authorize Aesthetic Body Design the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration.

    This authorization extends to all languages, media, formats and markets now known or

    This authorization shall continue indefinitely, unless I otherwise revoke this authorization in writing.

    I waive the right to inspect or approve any finished product in which my likeness appears, including written or electronic copy.

    I agree that I have been compensated for this use of my likeness or have otherwise agreed to this release without being compensated. I waive any right to royalties or other compensation arising or related to the use of the photograph.

    | understand and agree that these materials shall become the property of Aesthetic Body Design and will not be returned.

    I hereby hold harmless and release Aesthetic Body Design from all liability, petitions, and causes of action, which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.

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