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FACIAL + MASSAGE CONSULTATION INTAKE & AGREEMENTS 

If you have any questions while filling out this form, please do not hesitate to call our spa.

We highly encourage all guests to review their booking confirmation and visit our website to familiarize themselves with our spa policies and available services. This ensures you are adequately prepared and can enjoy your visit to the fullest extent. Thank you for helping us provide you with the best possible experience!

Today's Date: May 19, 2026

PAYMENT AGREEMENT & CANCELLATION PROCEDURES

A credit or debit card is required to secure all reservations. 

A minimum of 24 hours' notice is required to cancel, change, or reschedule appointments. No-shows and cancellations made within less than 24 hours of your appointment will result in a charge of 100% of the service cost. Rescheduling within 24 hours of your appointment incurs a $55 charge. If you are unable to attend your rescheduled appointment, the original price of the service will be charged. These charges will be billed to the default card on your client profile. For members, series holders, or package holders, the benefit for the appointment scheduled will be forfeited if canceled or rescheduled within 24 hours.

If your appointment is scheduled for Sunday, any rescheduling or cancellations must be done by phone by 7 pm on the Friday before, or notified via email (info@spakingston.com) at least 24 hours in advance.

We understand that unforeseen circumstances may arise; however, our policy is firm to ensure smooth operations and fairness to both our guests and technicians. Exceptions to our policy will not be made. Your missed appointment may be taking away the opportunity for another guest to receive that service. We are grateful for your understanding and cooperation.

I certify that all of the above information is true to the best of my knowledge AND I understand and agree with the payment, policy and cancellation procedures. By signing this form, I wave any and all claims, damages, action and liabilities against Spa Kingston arising out of or relating to skincare services and allergic reactions to products, services and health supplements suggested and/or sold.


*We kindly ask you to please silence your cell phones and as a reminder we are not able to have children or guests in the treatment room or waiting area who are not receiving a service. Thank you.*


First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
Information
Occupation: *
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Occupation: *
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Occupation: *
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Occupation: *
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Occupation: *
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Occupation: *
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Occupation: *
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Occupation: *
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Occupation: *
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information
Occupation: *
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Guest Information
Who may we thank for referring you? (First & Last name required for $25 referral credit) *
Do you have a technician preference? *
No preference
Female Preferred
Male Preferred
Female ONLY
Male ONLY
What brought you to our services today? (e.g., relaxation, pain relief, celebration, specific goals, etc.) *
Your Health

INTERNAL | EXTERNAL WELLNESS

Do you have any ALLERGIES? *
Please list any medications, supplements, vitamins, diuretics, slimming pills, etc. that you take regularly: *
Within the last year, have you been under a dermatologist or a doctors care?*
No
Yes
Within the last nine months, have you undergone any surgery?*
No
Yes
Our spa is not fully wheelchair accessible. Please inform us prior to your visit if you use a wheelchair or require mobility assistance so we can discuss accommodations.*
No
Yes
If you are under a doctor or dermatologist care or had surgery please specify the reason here. If you have had a recent surgery, please include whether you have been cleared by your physician to receive our services.
Do you have or have had in the past any of these health conditions?
Lupus
Sinus problems
Anemia
Raynaud's
Epilepsy
Diabetes
Heart problems
Herpes
Hypertension
Hormone Imbalance
Spinal Injury
Claustrophobia
Asthma
Hysterectomy
Thyroid condition
Varicose Veins
Systemic Disease
Cold Sores
HIV Positive
Other
Are you PREGNANT or trying to become pregnant?*
No
Yes
If you answered yes, please indicate which trimester you are in. If you are receiving a massage and are less than 12 weeks pregnant, please contact the spa right away to alert our staff. For your safety, we cannot offer massage services if you are less than 12 weeks pregnant.
Are you LACTATING?*
No
Yes
Do You Smoke?*
Do you wear contact lenses?*
What is your stress level?*

*Please inform your therapist before every visit if you have bruises, cuts, rashes, skin irritation or any changes to your health

BODY + MASSAGE

Both our massage and facial services provide a delightful combination of bodywork to enhance your experience. During our facials, we incorporate as much body massage as possible, primarily focusing on your head, neck, shoulders, arms, and hands. Our massage services are customized to meet your specific needs, ensuring a truly personalized and rejuvenating experience.

Have you received massage therapy previously?*
No
Yes
What type of massage do you prefer?*
What pressure do you prefer? *
Light
Medium
Deep

Are there areas you would like your therapist to FOCUS on? *

Please list areas of pain or discomfort to AVOID or be cautious of: *


SKIN + AESTHETICS 


Do you have any current skin concerns or goals?
Have you ever had a facial, chemical peel, laser, microdermabrasion or any resurfacing treatment?*
No
Yes
Do you use any topical medications such as ACCUTANE, Retin-A, Renova, Trentinoin, Isotrentinoin, Differin, Tazorac, Avage, EpiDuo, or Ziana?*
No
Yes
If yes, what topical medication are you using?
FACIAL TREATMENT AGREEMENTS

Chemical Peel Agreement

Do NOT use topical prescriptions, abrasive scrubs or exfoliants 7 days post peel.

No prolonged sun exposure 2 weeks post peel.

Sun protection of SPF 30-45 is to be applied every two hours when in direct sunlight.

I am currently not using any medications that are contraindicated to receiving a chemical peel. i.e. ACCUTANE, tretinoin, Retin-A, Renova, Differin, Tazorac, Avage, EpiDuo, Ziana, and high percentage AHA & BHA products.

Superficial to medium depth chemical peels are topical exfoliants applied to the skin to soften the dead skin layer and stimulate cell turnover restoring the skin to a more youthful appearance.

Many skin conditions can be improved when receiving a series of peels. Fine lines softened, dull skin is more radiant, rough & uneven skin becomes smoother. Sun damaged skin or hyperpigmented skin becomes more even. Acne scarring can soften.

I understand that anytime the skin barrier is compromised; there is a small risk of infection. I will contact my Aesthetician immediately should this happen.

I understand that following the treatment my skin may have slight or extreme redness, swelling, stinging, itchy, tenderness, dry or flaking skin. Risk of hyperpigmentation or hypopigmentation can occur.

I UNDERSTAND THAT I AM NOT TO PICK THE FLAKING SKIN AS THIS COULD CAUSE UNWANTED PIGMENTATION.

Most side effects will gradually diminish over time as healing may take several days or longer. I know I can NOT do strenuous exercise, swimming, or be in hot tubs, hot bath tubs, saunas or steam rooms for 24 hours of treatment time.

The chemical peel treatment has been fully explained and any questions or concerns that I have, have been addressed.

I acknowledge that no guarantee has been given to me as to the condition of the complexion, pore size, wrinkles or the percentage of improvement expected following treatment, due to each individual's unique reactions.

I understand that no specific results are guaranteed.

BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ THE ABOVE INFORMATION AND THEREBY CONSENT AND AGREE TO THE TREATMENT WITH ITS ASSOCIATED RISK. I HEREBY CONSENT TO RECEIVE A CHEMICAL PEEL.

_____________________________________


Microdermabrasion Consent

1. Prior to receiving this treatment, I have revealed any condition that may have a bearing on this procedure, such as pregnancy, recent facial peels or surgery, allergies, tendencies to cold sores and fever blisters. Use of Accutane is prohibited. It is recommended to delay use of tretinoin, Retin-A, Differin, Renova, Tazorac, Avage, EpiDuo, or Ziana 3 days prior to procedure.

2. I understand there may be some degree of minor discomfort, scratch lines from Microdermabrasion tip, rawness, sensitivity, ie; scratchiness.

3. I understand that to achieve maximum results, several ongoing treatments and use of daily products are recommended and there are no guarantees to this procedure.

4. I understand that the possibility of irritation, redness, and scratching exists and that I should notify my skin care professional if irritation persists.

5. I will follow the home care program specifically designed for me without changing or

adding any products without consulting with my skin care professional.

6. I have read the enclosed consultation and understand the content.

I agree to all of the above to have this treatment performed on me and will follow all prescribed directions regarding post Microdermabrasion care.

PHOTO AND VIDEO USE CONSENT FORM
I am allowing Spa Kingston to own, record, republish pictures of me/my property and reproductions of my likeness and my voice for educational, marketing, and publicity purposes through any media. I acknowledge that the pictures or recordings taken on this date then become the sole and exclusive property of Spa Kingston. I release Spa Kingston and it's agencies from any and all claims that might arise from use of these images and recordings. *
Agree
Disagree
Special Offer Text Preferences
Yes: Text messages regarding special offerings and updates are welcome
No: Please do not send promotional text messages
Appointment Adjustment Text Preferences
Yes: You may contact me if an appointment adjustment is needed
No: Please limit contact to confirmations only

Did you know Spa Kingston offers thoughtfully designed Memberships and Signature Series to support both consistency and flexibility—while offering exceptional value? Our Memberships provide exclusive savings on services along with complimentary, unlimited enhancements, free birthday service, and more...creating an elevated way to experience ongoing care. For those with more flexible or unpredictable schedules, our Buy 4, Receive 1 Complimentary Series offers the same value-driven benefit without commitment.

No matter your lifestyle, we offer beautifully curated options to help you save while prioritizing your well-being. We invite you to ask our team or contact the spa to discover which option is best suited for you. We look forward to welcoming you back and continuing to care for you.

Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Information
Occupation: *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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