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UV Tanning, Spray Tanning, Red Light, HydraFacial™, Dermaplaning, Cryotherapy, T-Shock, Lux Diamond Facial, Lux Oxygen Facial, Radio Frequency, EMS, Sculpt Pod Pro, and Compression Therapy User Agreement

PLEASE READ CAREFULLY BEFORE SIGNING


Danger – ULTRAVIOLET RADIATION

  • Follow operator, tanning unit, eyewear and safety instructions.
  • Exposure to the tanning process may cause skin cancer. Regular tanners should be regularly screened for skin cancer.
  • Avoid too frequent or lengthy exposure. As with natural sunlight, exposure to a sunlamp may cause eye and skin injury, sunburn, and allergic reactions.
  • Repeated overexposure may cause chronic damage characterized by wrinkling, dryness and premature aging of the skin.
  • Wear protective eyewear. FAILURE TO USE PROTECTIVE EYEWEAR MAY RESULT IN SEVERE BURNS OR LONG-TERM INJURY TO THE EYES.
  • Abnormal or increased skin sensitivity or burning may be caused by certain foods, medications, (included but not limited to tranquilizers, diuretics, antibiotics, high blood pressure medication, birth control pills and skin creams) cosmetics, or toiletries. Consult a physician or pharmacist before using a sunlamp if you are using prescription or non-prescription medications, have a history of skin problems, or believe yourself especially sensitive to sunlight. Pregnant women and women on birth control pills who use tanning device may develop discolored skin and should consult a physician before tanning.
  • Ultraviolet radiation from sunlamps enhances the effects of the sun. Do not sunbathe before or after exposure to ultraviolet radiation.
  • Clients takes full responsibility for any abuse or misuse of tanning equipment or related products.

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 consent to “before and after” photographs for the purpose of documentation, potential advertising and promotional purposes.

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.

Cryotherapy

Agreements:

  1. Follow all instructions given to you by the attendant. Do not use whole body cryotherapy / local cryotherapy without an attendant present.
  2. Participation in a whole body cryotherapy session involves exposure to extreme cold temperature for a short period of time (not to exceed three (3) minutes per session). Your clothing and skin must be dry. You must avoid inhaling the nitrogen gas that is emitted into the equipment. By signing this Agreement, you confirm that you are in good health and do not have any of the contraindications identified above or other physical condition that would preclude you from safely using whole body cryotherapy / local cryotherapy. You also agree to only using 1 Whole Body Cryo session per day maximum.
  3. If you experience any pain or mental or physical discomfort at any time during the process, you may terminate the session immediately. The chamber will not be locked, and you are free to walk out of the chamber at any time. You agree that you have familiarized yourself with this exit process and are prepared to do so if or when you feel it is necessary.

No representations or claims are made as to the therapeutic nature or other benefits of whole body cryotherapy / local cryotherapy. Whole body cryotherapy / local cryotherapy are not intended to diagnose, treat, cure or prevent diseases, illnesses, imbalances or disorders. No results from whole body cryotherapy / local cryotherapy are assured. Every customer is different and responds differently to the therapy.

Mandatory Safety Instructions for whole body cryotherapy / local cryotherapy:

  1.  You must wear our cotton or wool socks, briefs for men, to minimize the potential of chilblain and other potential injuries from over exposure to cold temperatures;
  2.  Sessions are limited to 3 minutes per session to minimize the potential for such adverse effects from over exposure to cold temperatures;
  3.  During the session, you must ensure that your head remains above the level of, and avoid inhaling, gasiform air
  4. (the cloudy gas circulating in the cryochamber); while non-toxic, it is devoid of oxygen and may cause shortness of breath, fainting, or other conditions;
  5. You must immediately notify the attendant and the end of the session if you at any time experience any
  6. physical or mental discomfort, problems, pain or anxiety;
  7. Abnormal skin sensitivity to cold may be caused by certain foods, cosmetics, lotions, piercings, or medication,
  8. including, but not limited to, tranauilizers and high blood pressure medication- do not use whole body cryotherapy / local cryotherapy if you have reason to believe you have come in contact with or ingested any such product.
  9. A person who is less than (18) years of age may not use whole body cryotherapy without written parental consent;
  10. A person who is less than (16) years of age may not use whole body cryotherapy even with parental consent.
  11. All body parts must have a comfortable clearance from the inner rim of the chamber during treatment.

Cryo T- Shock safely and effectively uses thermal shock to naturally destroy fat cells without any damage to the skin. The Cryo T-Shock breaks down fat cells, which your body naturally flushes out through the bloodstream and then the lymphatic system in days to weeks following the treatment. Cryo T-Shock also helps reduce the appearance of cellulite, fine lines and wrinkles by stimulating collagen and elastin production while tightening muscles. Cryo T-Shock is also beneficial for facial toning and lifting. Protocols will be discussed and or adjusted during consultation based on recommendations and client’s needs.

I understand that results may vary depending on individual factors including but not limited to medical history, prior treatments of area being treated, skin type, patient compliance with pre/post care instructions and individual response to treatment. I understand that for purposes of fat/cellulite reduction/skin toning, I must maintain good dietary habits, have sufficient intake of water and participate in light physical activity as well as comply with other items outlined during consultation.

• Cryo T-Shock should not be applied over inflamed, infected, or swollen areas of the skin.

• Cryo T-Shock should not be applied over/near cancerous areas or on clients undergoing active chemotherapy.

• Cryo T-Shock should not be used on clients who suffer from Kidney Disease.

• Cryo T-Shock should not be used on clients on dialysis.

• Cryo T-Shock should not be used on clients who are pregnant.

• Cryo T-Shock should not be used on clients who have an untreated abdominal hernia.

• Cryo T-Shock should not be used on clients who suffer from Severe Diabetes where sensation has been lost in the extremities.

I understand that any procedure involves risk. Risks may include redness, swelling, irritation, skin reaction, or increased heart rate. Some may experience delayed onset muscle soreness from treatments on the stomach due to unintentionally engaging the abdominals, which disappear later that same day.

I have been honest and forthright about my medical history, and am healthy to use the device. I am not pregnant, nor any other disease or condition that may be negatively impacted by the Cryo-T Shock Treatment.

Waiver and Release:

  1. This is a release of liability and a waiver of certain legal rights.
  2. By signing this Agreement you:

a.  acknowledge that use of whole body cryotherapy / local cryotherapy involves risk of bodily injury, illness, disability or death, which may be compounded by negligent emergency response of the attendant or inadequate ventilation of the room in which the equipment is operated. You acknowledge that you are voluntarily participating in whole body cryotherapy / local cryotherapy with knowledge of the dangers involved and accept and assume all risks of injury, illness, disability or death, whether caused by the condition of the facilities or equipment or the negligence of the attendant or otherwise. You acknowledge that frostbite is a specific risk that you assume.

b.  expressly waive and release any and all claims against Company, Impact Cryotherapy, Inc., and their respective officers, directors, employees, agents, affiliates, successors and assigns (which are collectively referred to as “the Released Parties”), arising out of or attributable to your use of whole body cryotherapy / local cryotherapy. You covenant not to assert any such claims against the Released Parties, and forever release and discharge the Released Parties from liability for such claims.

c.  indemnify and hold harmless the Released Parties from any loss, liability, damage, cost or expense arising out of or connected in any manner with your use of whole body cryotherapy / local cryotherapy.

d.  agree that this waiver and release is intended to be as broad and inclusive as permitted under law. You specifically acknowledge and agree that this Agreement is not intended to be a general release subject to limitations and conditions that would otherwise apply under applicable state law and additionally agree to waive all general release limitations provided by applicable law.

General Provisions:

  1. This Agreement shall be construed and interpreted as broadly as possible under the applicable law of the jurisdiction in which you use whole body cryotherapy / local cryotherapy, with the words, terms, provisions, covenants, and remedies contained in this Agreement to be enforceable to the fullest extent permitted by applicable law.
  2. If any portion of this Agreement is held invalid, the remainder shall not be affected and shall continue in full legal force and effect.
  3. The terms of this Agreement shall continue from this date forever and shall apply to each use by you of whole body cryotherapy / local cryotherapy without the need for you to re-execute this Agreement.
  4. This document constitutes the entire agreement regarding your use of whole body cryotherapy / local cryotherapy and any product, services or equipment connected with the Released Parties and supersedes all prior discussions, agreements and representations about the use, benefits or risks of whole body cryotherapy / local cryotherapy. This Agreement may only be modified in a writing signed by you and an authorized representative of the Company.  

Risks of whole body cryotherapy and local cryotherapy include, but are not limited to: fluctuations in blood pressure (due to peripheral vasoconstriction, systolic blood pressure may briefly increase by up to 10 points during the session. This effect should reverse after the end of the session, as peripheral circulation returns to normal), allergic reaction to extreme cold (rare), clautrophobia, anxiety, activation of some viral condtion (cold sores) etc. due to stimulation of the immune system. One primary inherant risk of cryotherapy is skin senstivity and skin irritation. It is impossible to predict how client’s skin will react during or after cryotherapy.

Normatec Pulse Technology Contraindications: Do not use Normatec Pulse technology if you have any of the following conditions: current or unstable fractures or breaks, recent surgery, sutures, stitches, open wounds, or abrasions. If you have any other injury, illness or medical condition you should consult your physician prior to using Normatec.

Fire N Ice Spray Active Ingredients: The following are the active ingredients in the Fire and Ice Treatment.   Some of these ingredients could have an allergic or a negative reaction. This product is not intended to diagnose, treat or cure or prevent disease. These statements have not been evaluated by the Food and Drug Administration: Water, Caprylic/ Capric, Triglycerides, Polysorbate 60, Glycerol, Propylene Glycol, L-2- Aminopropanoic Acid, Inosine, Niacinamide, Glycine, Methyl Nicotinate, L-Histidine, Copper Peptides, Phosphatidyl Choline, d-Tocopherol and mixed (alpha, beta, gamma, delta) Tocopherols, Ascorbyl Palmitate, Lyso Phosphatidyl Choline, Oleic Acid, Pyridoxal-5-Phosphate, Ethanol, Glyceryl Stearate, phenoxyethanol, Rosmarinus Officinalis.

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 and all sales are final. 

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 REULTING 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.

 

Date: February 27, 2024

First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future 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
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future treatments. I will alert the staff If there are any future changes to my medical history.


Second Client's Signature*
Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future treatments. I will alert the staff If there are any future changes to my medical history.


Third Client's Signature*
Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future treatments. I will alert the staff If there are any future changes to my medical history.


Fourth Client's Signature*
Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future treatments. I will alert the staff If there are any future changes to my medical history.


Fifth Client's Signature*
Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future treatments. I will alert the staff If there are any future changes to my medical history.


Sixth Client's Signature*
Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future treatments. I will alert the staff If there are any future changes to my medical history.


Seventh Client's Signature*
Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future treatments. I will alert the staff If there are any future changes to my medical history.


Eighth Client's Signature*
Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future treatments. I will alert the staff If there are any future changes to my medical history.


Ninth Client's Signature*
Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future treatments. I will alert the staff If there are any future changes to my medical history.


Tenth Client's Signature*
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Skin Type:*
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, and all allergies to cosmetics, toiletries, and tanning accelerators.
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:
Have you ever been told by a medical provider to avoid the sun?*
No
Yes
Are you pregnant/lactating?*
No
Yes
Have any metallic implants such as pins, prostheses, nonremovable jewelry, or pacemakers*
No
Yes
Long-term steroid use *
No
Yes
Open lesion or cold sore*
No
Yes
An active infection in the treatment area*
No
Yes
Active sunburn*
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
Cancer at any time and in any form *
No
Yes
Undergoing chemotherapy or immune therapy *
No
Yes
Untreated abdominal hernia*
No
Yes
Urinary incontinence *
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
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
Do not use Whole Body Cryotherapy if you have any of the following conditions, check all that apply:
Uncontrolled high blood pressure
Prior heart attack
Unstable chest pain
Disease of blood vessels
History of blood clots
Cold Allergy
Open sores
Nerve pain in feet or legs
Pregnancy
Joint Disease
None

If you've selected any of the boxes above, please explain the details of each.
Please check each service that you may be interested in: *
UV Tanning
Spray Tanning
HydraFacial
Dermaplaning
Cryo T-Shock
Whole Body Cryo
Local Cryo
Compression Therapy
Fire N Ice Facial
Red Light Therapy
Lux Facials
EMS
Radio Frequencey
Sculpt Pod Pro
Waxing
Tinting
EmFace
What is your skin type? *
Normal Skin Type
Oily Skin Type
Blackheads
Breakouts
Sensitive/ Redness

List any skin concerns:
If you are doing Spa Facial and/or Body 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 Facial and/or Body 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 some spa treatments. 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.
  • By signing below, I acknowledge that I have read the above information and give my consent to be treated with the selected treatment. This consent form Is valid for all future 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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