Bella Fiore Organic Med Spa:New Client Intake Form
New Client Intake Form
March 1, 2021
Please List Any:
I understand (even though I may not be getting waxed today) that waxing may have certain side effects such as skin removal, redness, swelling, tenderness, or other complications.
I do not have any open lesions or active herpes outbreak, oral or genital, if applicable to the area being treated. (Please understand that active cold sores are contraindicated for any light-based devices.)
Please initial to show you have read the above:
I understand, have read and completed this questionnaire truthfully. I agree this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin or negative effects on the body from treatments received. The treatments I receive here are voluntary and I release this institution, skin care professionals and/or massage therapists from liability and I assume full responsibility thereof.