Privacy of personal information is an important principle to Essentials South Tampa Day Spa. We are committed to collecting, using and disclosing personal information responsibly and only to the extent necessary for the goods and services we provide. 

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Essentials South Tampa Day Spa

4811 W. Gandy Blvd.

Tampa, Fl 33611


Review Essentials South Tampa Day Spa Privacy Policy

PLEASE READ/INITIAL THAT YOU UNDERSTAND THE FOLLOWING POLICIES:

LATE ARRIVALS: We regret that late arrival for your appointment may deprive you of valuable treatment. 


 

CANCELLATION POLICY: Please be aware that we require 24-hour advanced notice for all appointment cancellations. Voicemail messaging is available 24 hours a day for your convenience. Missed appointments without proper notice may be subject to a $35 cancelation fee, or a $35 no-show fee. You will be required to either prepay for future appointments or put a credit card on file to charge future cancellation fees. If there is no card on file, the full amount of the missed service will be collected before another appointment can be scheduled. 


 

MEDICAL: For your protection, please inform us of any medical conditions or other special needs that may require our attention to make your visit a pleasant one. This includes skin care products that may interfere with facial and waxing services. In the event your health history changes, please notify us and complete a new Client Intake Form. 


 

I understand that the massage I receive is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any discomfort during the session, I will immediately inform the practitioner, so the pressure may be adjusted to my level of comfort. I further understand that a Licensed Massage Therapist (LMT) can neither diagnose illness, disease or any other medical, physical, or mental disorder; nor perform any spinal manipulations. I am responsible for consulting a qualified physician for any ailment that I have. Because a LMT must be aware of any change in my physical health, I understand there shall be no liability on the practitioner’s part or Essentials South Tampa should I fail to do so. I also understand that any sexually suggestive remarks of advances made by me will result in immediate termination of the session, and I will be liable for payment of the scheduled appointment.

I hereby give my consent and authorization voluntarily and release Essentials South Tampa from any claims, implied or stated that, I have or may have in the future with this treatment/service, regardless of result. I am stating that the treatment/service and precautions above have been explained to me in detail and that I fully understand.

CONSENT FOR TREATMENT

Please read and initial next to the treatments you are receiving today.

FACIAL CONSENT

I understand that facials involve the use of skincare products, exfoliation, extractions, masks, and/or equipment to improve skin health and appearance. Possible risks include temporary redness, irritation, dryness, or sensitivity. I have disclosed all relevant skin conditions and allergies. I agree to follow post-treatment care instructions (e.g., avoiding sun exposure, using sunscreen).

I consent to receiving a facial. 


MASSAGE CONSENT

I understand that massage involves manual manipulation of muscles and tissues to promote relaxation and pain relief. Possible risks include temporary soreness, bruising, or discomfort. I have disclosed all relevant medical conditions and injuries that may affect my treatment. I agree to communicate any discomfort during the session.

I consent to receiving a massage. 


POST-TREATMENT INSTRUCTIONS

  • Facials: Avoid direct sun exposure, heavy makeup, or harsh products for 24–48 hours. Use sunscreen daily. Stay hydrated.
  • Massage: Drink plenty of water, avoid strenuous activity for 24 hours, and report any unusual soreness.

Today's Date: October 31, 2025

First Client's Name
First Name*
Last Name*
Phone*
Select Gender
First Client's Date of Birth*
Date of Birth
First Client's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
First Client's Signature*
Second Client's Name
First Name*
Last Name*
Phone*
Select Gender
Client's Date of Birth*
Date of Birth
Second Client's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
Third Client's Name
First Name*
Last Name*
Phone*
Select Gender
Client's Date of Birth*
Date of Birth
Third Client's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
Fourth Client's Name
First Name*
Last Name*
Phone*
Select Gender
Client's Date of Birth*
Date of Birth
Fourth Client's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
Fifth Client's Name
First Name*
Last Name*
Phone*
Select Gender
Client's Date of Birth*
Date of Birth
Fifth Client's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
Sixth Client's Name
First Name*
Last Name*
Phone*
Select Gender
Client's Date of Birth*
Date of Birth
Sixth Client's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
Seventh Client's Name
First Name*
Last Name*
Phone*
Select Gender
Client's Date of Birth*
Date of Birth
Seventh Client's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
Eighth Client's Name
First Name*
Last Name*
Phone*
Select Gender
Client's Date of Birth*
Date of Birth
Eighth Client's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
Ninth Client's Name
First Name*
Last Name*
Phone*
Select Gender
Client's Date of Birth*
Date of Birth
Ninth Client's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
Tenth Client's Name
First Name*
Last Name*
Phone*
Select Gender
Client's Date of Birth*
Date of Birth
Tenth Client's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
Client'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:*
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Additional Information
Check here to opt in for SPECIAL PRICING, Events, Spa Updates, through text messaging.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information

Health And Medical History

Please provide accurate information to ensure your safety. Check all that apply or write “None” if applicable.

Current Medications or Supplements:
Allergies (e.g., to skincare products, essential oils, nuts):
Medical Conditions (e.g., diabetes, heart disease, epilepsy, pregnancy):
Skin Conditions (e.g., acne, rosacea, eczema, sensitivity):
Recent Surgeries or Injuries (e.g., within the last 6 months):
Musculoskeletal Issues (e.g., back pain, joint issues, recent sprains):
Other Health Concerns:
Are you pregnant or breast feeding? *
No
Yes
Do you have any contagious conditions (e.g., cold sores, skin infections)? *
No
Yes
Have you had a facial or massage in the past? If yes, any adverse reactions?

Treatment Preferences and Goals

Please indicate the services you are interested in today:
Facial (e.g., hydrating, anti-aging, acne treatment)
Massage (e.g., Swedish, deep tissue, relaxation)
Specific Concerns or Goals (e.g., reduce acne, relieve muscle tension, relaxation):
Preferred Massage Pressure (if applicable): *
Light
Medium
Firm
Product Preferences (e.g., fragrance-free, organic, vegan):
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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