NEW CLIENT INTAKE FORM

 
Name *
Name
Address *
Address
Have you been exposed to any tanning method in the past 24 hours?
Do you smoke?
Do you get sore/fever blisters?
Are you pregnant or trying to get pregnant?
Are you epileptic or suffer from seizure, have any metal implants, or pacemaker?
Describe your skin
Mark all that apple
Agreement *
By checking this box I fully understand all of the questions above and have answered them correctly and honestly. Furthermore, I know that it is my responsibility to alert the technician, upon every visit, about recent medical or physical conditions that have occurred. Without the above disclosure, I understand that the attending technician cannot optimize the effectiveness of any treatments or therapies. By checking this box, I consent to all procedures and treatments done at this facility and do not hold the technician or facility responsible for any complications incurred during any treatments and procedures today or in the future.
Cancellation Policy *
By checking this box I agree to the following cancellation policy: In the even you must cancel or reschedule an appointment, please allow 24 hours. No shows will be charged in full. Late arrivals will receive the best possible service in the remainder of their allotted time.