Please fill out the following form.

Have you ever had a facial before?
Are you currently pregnant?
Do you smoke?
How much exposure to the sun do you get?
Do you have any food or drug allergies?
Do you take medication for any skin condition ?
Are you currently using any products that contain glycolic acid, lactic acid, alpha hydroxy acids, retinol, or prescription creams?


In consideration for receiving services at the "Spa", I hereby release, waive, discharge, and covenant not to sue the Spa from any and all liability, claims, demands, actions, and causes of action related to any loss, damage, or injury that may be sustained by me or property belonging to me, whether caused by negligence or otherwise on the Spa premises. I am fully aware of the risks involved in the services which may be rendered, which may include, but are not limited to: allergic reaction, scarring, numbness, tingling/pain, etc. and hazards connected with skin care treatments. I voluntarily assume full responsibility for any risk of loss, property damage, and personal injury, that may be sustained by me, or any loss or damage to property owned by me, whether or not caused by negligence or otherwise.

Thanks for submitting!