PERSONAL INFORMATION Full Name(Required) First Birthday(Required) Phone Number(Required)E-mail(Required) Do you have our membership?(Required) Yes No How did you find us:(Required) EMERGENCY INFORMATION Contact Name:(Required) Phone Number:(Required)Relationship:(Required) SERVICE : Please check the service / treatment you came in for BODY Bikini Brite Peel Body SCULPTING BUTTOCK SCULPTING CELLULITE TREATMENT Coolsculpting Intimate Bleaching LASER HAIR REMOVAL PRP HAIR RESTORATION Spider Vein Treatment ULTRASONIC CAVITATION VI PEEL BODY FACIAL HYDRO-FACIAL GUINOT SKIN CARE MICROCURRENT TREATMENT MICRODERMABRASION FIBROBLAST PLASMA BEAUTY INJECTIONS VI PEEL PRECISION PLUS PRP Facial EUREKA FACIAL Juvéderm facial Extraction MASSAGE Couples Massage LYMPHATIC DRAINAGE THAI HERBAL BALL SCULPTING BUCCAL GUA SHA MASSAGE Other Treatment Area Payment Methods Untitled Credit card Voucher Gift Card Payment Plans Cash Other Spa Policies We recommend making appointments for all services as early as possible to ensure that we can accommodate you with your choice of time and staff. Please call us at (212)-858-0706 to book or cancel all appointments. As a courtesy to our clients and staff, it is company policy for all clients to give 24 hours' notice of cancellation. If you cancel the SAME DAY or NO SHOW for your appointment, we will deduct a treatment from your package. Or be charged $75 cancelation fee. We don't accept second GROUPON voucher, only once, your next voucher you can purchase in the office. Gift certificates & vouchers that are expired will be accepted at half of the face value for 30 days after the expiration date. After that, the gift certificate or voucher will be void. All year laser hair removal includes 8 sessions. We will do our best to accommodate late arrivals; however we do value the next clients appointment time so it may be necessary to shorten your service or reschedule at management's discretion. Payments by cash, Visa, and MasterCard are accepted. The prices of services are subject to change without notice. Git Card Refund Policy: No refunds are given for gift card orders and gift card orders are not exchangeable. No refund will be given for partially used package purchases. We are not responsible for loss or damages of personal items. Our services do not include tax or gratuities. Taxes are to be paid upfront prior to starting services. In appreciation and part of the staff salaries, gratuities may be given at your discretion. Services provided are at your own risk. All medical and cosmetic procedures are associated with certain risks and may result in complications. Temporary burns, bruises, redness, soreness, and irritation are possible side effects, especially on type of skin, such as sensitive skin, dark skin, any type of skin after tanning and skin with tattoo images. It is important to shave the area prior to treatment session. (We do not provide shaving services, as you must do this yourself prior to the treatment). You are responsible for notifying your technician if you are pregnant, taking any new medications, allergic to Aloe, or have been diagnosed with an illness, as this may make you ineligible for treatment. By signing below you agree to the following. The Spa and/or the individuals working at The Spa shall not be held liable for any damages, injuries, or adverse effects that may occur as a result of receiving services at our establishment after the period of three (3) months has elapsed from the date of service. Regardless of the nature or extent of any such adverse effects, The Spa shall bear no responsibility for any claims arising thereafter. The limitation of liability and waiver of claims as outlined in this document shall apply to all services provided by The Spa, including but not limited to body treatments, massages, facials, laser hair removal, fat freeze and any other spa services offered by The Spa. By receiving services at The Spa, you acknowledge and accept that any adverse effects or consequences that may arise after the aforementioned three (3) month period shall be your sole responsibility and The Spa and its employees shall be released from any liability. By signing below and continuing to use our services, you confirm that you have read, understood, and agreed to the terms and conditions outlined in this document.Have you ever had: Ultrasonic-cavitation, Cool sculpting, Guinot facials, Micro needling, PRP. Microdermabrasion, Botox, Juvéderm, or Laser hair removal done before? If so, which: Are you presently taking any medications, vitamins, or supplements? Do you take Accutane for last 6 month?(Required) Yes No List here Do you have hearing implants? (If, yes you can't do ultrasonic-cavitation procedure)(Required) Yes No Do you suffer from skin problems?(Required) Yes No If so, which: Have you had surgery before?(Required) Yes No If so, explain: Do you have any tattoo images, metal implants, pacemaker, or prostheses?(Required) Yes No If so, explain: Are you pregnant (might be) or nursing?(Required) Yes No Are you epileptic?(Required) Yes No Do you have any kind of tumor or cancer?(Required) Yes No Do you have any cardiac or vascular disease or condition?(Required) Yes No Do you have any acute inflammation?(Required) Yes No Do you have wound that has not healed?(Required) Yes No Do you have current or any history or internal bleeding?(Required) Yes No Do you have any type o heart, kidney or liver disease?(Required) Yes No Do you have any abnormally high or low blood pressure?(Required) Yes No Do you take Anti-inflammatory, Anticoagulants, Antibiotics, Antihistamine?(Required) Yes No Do you have HIV?(Required) Yes No Full Name(Required) First Date(Required) MM slash DD slash YYYY Signature(Required)
