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Spa Services Waiver

PLEASE READ CAREFULLY BEFORE SIGNING

HydraFacial

HydraFacial is the only hydra-dermabrasion procedure that combines cleansing, exfoliation, extraction, hydration and antioxidant protection simultaneously, resulting in clearer, more beautiful skin with little-to-no downtime. The treatment is soothing, moisturizing, non-invasive and generally non-irritating. As with most procedures, visible results from HydraFacial will vary from person to person.

Lux Oxygen Facial

The Lux Oxygen Facial is a non-invasive treatment. It uses a vacuum applicator to draw in the skin tissue to clean and exfoliate the skin, as well as an oxygen handpiece to deliver serums to the skin. The treatment is soothing, hydrating, non-invasive and generally non-irritating. As with most procedures, visible results from Dermabrasion Facial will vary from person to person.

What to expect from HydraFacial and Lux Oxygen Facial:       

  • Your skin may experience temporary irritation, tightness, or redness. These are all normal reactions that typically resolve within 72 hours depending on skin sensitivity. 
  • You may experience tingling and stinging in the treatment area. These sensations generally subside within a few hours.  
  • Client experiences may vary. Some clients may experience a delayed onset of these symptoms.
  • You will likely see results immediately after treatment and your skin may feel smooth and hydrated for one to four weeks with appropriate home care to maintain treatment results.
  • The skin is more susceptible to sunburn/sun damage. Avoid excessive sun exposure and use a minimum of SPF 40 sunscreen.

*Make sure to avoid alpha-hydroxy acid, glycolic acid products, Retin-A, Salicylic Acid, Hydroquinone, and skin exfoliation scrubs for 72 hours both before and after treatment. Also avoid swimming and stay out of direct sunlight after treatment.

Sculpt Pod Pro

The massage/vibration plate in the Sculpt Pod vibrates your body softly while you receive red light and infrared at the same time. This stimulates the body to release lymph fluid. This fluid is full of toxins and fat - the red light is shrinking the fat cells where they eventually (this is why multiple seasons are needed) pop open and is carried out in the lymph fluid. Your body drains this fluid naturally by sweating and urinating. As with most procedures, visible results from Sculpt Pod Pro will vary from person to person.

If you do not follow the instructions for your sessions, you will not see BEST results. For best results, please come 3 days per week with one day in between sessions. Best results are with 10-16 Sessions. Most will start seeing results within 3 sessions but need more then just 3 sessions for long term results. We recommend drinking one bottled water before and one bottled water after your sessions. YOU MAY ONLY USE THIS MACHINE ONCE EVERY 24 HOURS PER STATE LAW. WE MAKE NO CLAIMS THAT THIS MACHINE CURES ANY DISEASE.

NEVER USE THE SCULPT POD IF YOU ARE PREGNANT, BREAST FEEDING OR HAVE A HEART CONDITION.

Use caution with persons sensitive to light and heat. Do not use if you're taking medication that makes you sensitive to light or heat.

ALL jewelry must be removed.

NO METAL IMPLANTS OR UNDERWIRE. Titanium implants are approved. 

Do not put Hot Cream on breast or sensitive areas like nipples. Only use Hot Cream on fatty areas such a stomach, legs and buttocks. If Hot Cream gets under "folds" of skin, wipe off with baby wipe or towel. Do not get the Hot Cream on face or in eyes. Make sure you're not sensitive or allergic to any ingredients in the hot cream. Certain medications or other applied lotion/products on skin prior the session may have a photosensitive reaction.

DO NOT EAT ONE HOUR BEFORE OR ONE HOUR AFTER YOUR SESSION. PLEASE DRINK ONE BOTTLED WATER AFTER YOUR SESSION TO FLUSH FAT AND TOXINS OUT.

Do not use the Sculpt Pod after receiving a laser hair removal or any invasive or noninvasive treatments.

Please remember that by sweating in the Sculpt Pod your body eliminates toxins and this could cause a rash. Clients who do not hydrate properly can be prone to such reaction.

Each Sculpt Pod has a weight limit of 300 pounds.

We suggest women to wear a sports bra and panties, Men just underwear.

EMS

The Electronic Muscle Stimulator produces micro-currents via the electrodes. It impulses the motor nerves so that the targeted muscle groups have to exercise passively in the way of expanding and contracting. It enhances muscle strength, endurance, reduces fat, helps to remove toxins, relieve pain, and can enhance the metabolism by improving blood circulation.

I understand there are certain contraindications that would preclude me from receiving EMS treatments, including autoimmune disorders, diabetes, embolism, epilepsy, melanoma, metal implants including plates/pins/screws, open wounds, pacemaker use, phlebitis, pregnancy, thrombosis, and varicose veins.

I understand that Electric Muscle Stimulation treatments involve conducting mild electrical currents through the body, and that this brings some inherent risk.

I understand that reactions are rare, but may include nausea, dizziness, weakness, and possible skin reactions including redness and/or other irritations.

I understand that while the goal of this treatment is to improve muscle tone and reduce fat, no specific guarantees of the result can or have been made.

I understand that it is imperative to my health that I disclose all of the information requested in the Client Profile/Health History.

I have cited all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products or medications.

I understand that additional conditions could occur or be discovered during the procedure which could affect my ability to tolerate the procedure.

I understand that if I have any concerns, I will address these with my specialist. I give permission to my specialist to perform the Electric Muscle Stimulation procedure we have discussed, and will hold him/her and his/her staff harmless and nameless from any liability that may result from this treatment. I have accurately answered the questions above, including all known allergies, prescription drugs, conditions, or products I am currently ingesting or using topically. I understand my specialist will take every precaution to minimize or eliminate negative reactions as much as possible. In the event I may have additional questions or concerns regarding my treatment, I will consult the specialist immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. I do not hold the specialist, whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed. 

Radio Frequency

The RF electrical pulses travel into the dermal layer (through the previously applied conductive gel) and tighten the fundamental building blocks of the skin- elastin and collagen fibers. RF also stimulates the production of hyaluronic acid with no pain and no downtime.

All clients must review the Radio Frequency contraindications and agree that none apply before receiving treatment.

I understand and agree that under no circumstances will a client be permitted to use any service while intoxicated.


I understand and agree that all Sessions will expire 2 years from the date of purchase.


BY SIGNING BELOW, I ACKNOWLEDGE AND CERTIFY THAT I HAVE READ AND UNDERSTAND THE "CONSENT, RELEASE AND INDEMNITY AGREEMENT" FOR THESE TREATMENTS, AND THAT I AM SIGNING IT VOLUNTARILY. I HOLD LUX TAN & CRYO, AND ITS AFFILIATES, ET AL HARMLESS OF ANY ADVERSE EFFECTS OR EVENTS RESULTING FROM USE OF THESE SERVICES OR PRODUCTS. SHOULD ANY PAIN OR DISCOMFORT OCCUR I WILL IMMEDIATELY NOTIFY THE LUX TAN & CRYO STAFF. I UNDERSTAND THAT I MUST BE AT LEAST 18 YRS OLD TO PARTICIPATE IN THESE TREATMENTS. I UNDERSTAND THAT ALL SALES ARE FINAL AND REFUNDS ARE NOT PREMITTED. LUX TAN & CRYO RESERVES THE RIGHT TO CANCEL MEMBERSHIPS AND/OR USE OF SERVICES AT ANY TIME.

September 28, 2022

First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
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.
FOR MINORS ONLY:

Emergency Contact
How did you hear about us?
How did you hear about us?*
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*
Parent or Guardian's Information
Are you currently taking any photosensitizing medications or using any products that could make your skin sensitive?*
No
Yes

Please list any and all prescriptions/nonprescription medications that could make your skin sensitive, and all allergies to cosmetics and toiletries
Do you have any health issues or injuries that would prevent you from safely using any of our services?*
No
Yes

If yes, please explain:

Do you have any of the following?

Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
No
Yes
Insensitivity to Heat or Light*
No
Yes
Skin conditions such as eczema, dermatitis, or rashes*
No
Yes
An autoimmune disease such as lupus*
No
Yes
A viral concern such as HIV or hepatitis*
No
Yes
Current treatment with anticoagulants, anti-inflammatories, or antibiotics *
No
Yes
Long-term steroid use*
No
Yes
Melanoma or lesions suspected of malignancy*
No
Yes
Active acne or infection*
No
Yes
Infectious or Contagious Skin Conditions*
No
Yes
Broken Bones*
No
Yes
Pregnancy or lactation*
No
Yes
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Crohn's Disease, Hyperthyroidism, Deep Venous Thrombosis, Lymphedema, and/or Infection in the urinary system i.e. kidneys, bladder and urethra. (Lymphatic drainage)*
No
Yes
Urinary Incontinence*
No
Yes
Erythema*
No
Yes
Heart Condition*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, pacemaker, or defibrillator*
No
Yes
Neurological disorders such as epilepsy (LED Lights)*
No
Yes

Have you recently?
Saying yes does not preclude you from receiving treatments.

Used Accutane, topical medications or antibiotics*
No
Yes
Had aesthetic fillers, injectables or laser treatments*
No
Yes
What is your skin type? *
Normal
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa treatments, do you give permission for photographs and other audio-visual and graphic materials to be used for marketing, education-promotion purposes. Although the photographs or accompanying material will not contain my name or any other identifying information, I am aware that I will not be identified in the photos.*
No
Yes
Each person has a different response to the Spa treatments. The risks, benefits, and possible results have been explained to me. I have been provided the opportunity to ask questions and received satisfactory responses. Do you agree to have your photograph taken to document your results and they will not be used for marketing unless agreed upon (see above).*
No
Yes

I acknowledge the following:   

  • I will avoid the use of aggressive exfoliation, waxing, and products containing glycolic acids or retinols that are not part of the recommended take-home regimen in the treated areas for minimum 2 weeks pre and post-treatment. 
  • Photos may be taken before, during and after the Spa treatment. Photos will only be used with my written approval for education, promotion or advertising purposes.
  • The information provided has been explained to me and all my questions have been answered to my satisfaction. I have read the above information, and I give my consent to have the Spa treatment by the staff at Lux Tan & Cryotherapy.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the Spa treatment System. This consent form Is valid for all future Spa treatments. I will alert the staff If there are any future changes to my medical history.
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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