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Informed Consent

Facials & Back Treatments




Please read carefully before signing the waiver and consenting to have Facials, and Back Treatments at Ease Medspa Wellness.

1, Company Policies:

24-hour Cancellation / Rescheduling Policy:

As a courtesy, we will send appointment reminders 48-hour in advance via email, and 24-hour in advance via text message.

I understand that it is my responsibility to notify Ease Medspa Wellness at least 24 hours before my appointment if I need to Cancel or Reschedule.

I understand that I can Cancel or Reschedule via:

  • Text: (646) 210-3296
  • Email: info@easemedspa.com
  • Call: (212) 625-8966

No Show Policy:

I understand that if I miss my appointment without informing Ease Medspa Wellness 24-hours (48-hours for Full-body) in advance, it will be recorded as a “No Show” in my file. 

I understand the 24 hours Cancellation, Rescheduling and No Show policy; and I agree to pay $30 fee, if I fail to cancel or reschedule 24 hour in advance. The same rule applies to No Show appointments. 

Taxes and Gratuities:

I understand that Taxes and Gratuity are not included in the cost of the service. Industry standard is 15-20% of the original price, please feel free to extend a gratuity as a result of your experience. Gratuity in Cash or Venmo is always appreciated! I do understand all sales are final and not refundable.

​


2. What Treatments we perform?

The Custom Facials are personalized experiences based on your concerns and goals.

The Back Facial Treatment is a purifying and results-driven treatment performed on your back.

The DiamondGlow™ is an advanced skin-resurfacing treatment with the 3X1™technology that exfoliate, extract debris, and infuses the skin with medical-grade serums, volumizes skin by 70% with no downtime.

The BioRePeel® is the latest and a complete Italian-made aesthetic peeling treatment for all skin types with minimal-zero downtime. It targets the dermis with the goal of stimulating new skin growth and improving the skin surface texture, imperfections, and accelerates cell turnover. It delivers an instant result and continue to improve over the following weeks.

The PCA Peels / Glow Peels treatments can be used to diminish the appearance of fine lines and wrinkles, improve skin tone, reduce pore size, increase hydration and moisture retention. Layers of product are applied based on your unique skin composition and needs.

The Dermaplaning is a safe, non-invasive treatment to exfoliate and smooth the skin using a scalpel blade to gently scrape off the top layer of dulling dead skin cells and peach fuzz, and achieve a smoother, brighter complexion.

​The Facial Acupuncture is a non-surgical cosmetic treatment to obtain natural younger and healthy skin using the finest and hair-like needles for a vital and youthful facial appearance. 

Dated: February 22, 2025

First Client's Name

First Name*

Last Name*

Phone*
First Client's Age Acknowledgment*
First Client's Date of Birth*
I certify that I am 18 years of age or older
First Client's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
Parent or Guardian's Email Address

Email*

Confirm Email*
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

General Health Information


Are you currently pregnant?*
No
Yes
Are you currently breastfeeding?*
No
Yes
Do you have any allergies?*
No
Yes
Are you taking any medication for Acne?*
No
Yes
Have you experienced skin sensitivity to any product or facial treatments?*
No
Yes

Skin Evaluation

Choose one of the following which best describes your skin type:
Normal
Oily
Dry
Combination
Sensitive
Which skin treatment(s) would you be interested in at Ease Medspa?*
Custom Facials
Back Facial Treatment
BioRePeel®
Dermaplaning
DiamondGlow™
Chemical Peels
Microdermabrasion
Facial Acupuncture
Micro-current Lifting Facial
LED Light Skin Therapy

I hereby agree and confirm that:

  • I understand that the treatments and services provided by Ease Medspa & Wellness Group are intended for general wellness purposes and are not intended to substitute professional medical treatment for any condition, medical or otherwise;
  • I have disclosed all my known health conditions, limitations, allergies and physical ailments to Ease Medspa & Wellness Group, and agree to keep such information up to date and accurate;
  • I understand the product(s) and treatment(s) to be provided to me and my queries on the same (if any) have been addressed to my satisfaction, and I agree to accept any risks arising in connection therewith; and
  • I shall fully release, indemnify and hold harmless Ease Medspa & Wellness Group and its employees from and against all liabilities, claims, expenses arising out of or in connection with the products and treatments provided to me.
  • I further agree that this consent supersedes any previous verbal or written disclosures, and shall remain valid for all future treatments.
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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