General Treatment Consent Form

Caribbean Day Spa General Treatment Consent Form

The Caribbean Day Spa clinical facial or body treatment may consist of surface cleansing, exfoliation, (enzyme, glycolic, lactic,TCA and salicylic peels, microdermabrasion, dermaplaning), steam, extractions, corrective serum and mask application, hair removal by waxing, body scrubs, wraps, massage, aromatherapy. Clinical treatments take approximately 30-90 minutes to complete and are designed to restore skin health and beauty as much as possible in the scheduled time. Implements and equipment used in all Caribbean Day Spa procedures are disposable or properly sterilized according to the State Board of Cosmetology regulations. Clinical therapists may wear surgical gloves, face mask or eye goggles throughout the entire procedure to insure sterile techniques.

IMPORTANT:

Please indicate below that you agree to the following:

1. Avoid direct sunlight following a clinical facial.
2. Wait 24 hours following a clinical facial before using Glycolic Acid and Retinoid products.
3. Avoid using scrubs or depilatories for 48 hours following the clinical facial.
4. Do not pick your skin following a clinical facial.
5. Avoid strenuous exercise for 24 hours following a clinical facial or body treatment.
6. If using Retinol products do not have facial waxing.

I have read and understand the important information above and I will follow the guidelines specified *

Agree Disagree

I have informed my skin care specialist of any health problems of which I am aware and all medications I am taking, particularly Accutane, Retinoids and topical prescription drug therapies. I understand that skin rejuvenation is best achieved through a series of recommended treatments and compliance to the home care product program recommended by my Skin Care Specialist. *

Agree Disagree

BODY CONSENT

Please indicate below that you agree to the following:

I understand it is my choice to receive massage therapy and/or body treatments. I realize that the treatment is being given for the well being of my body and mind, to relieve stress, muscular tension, spasm or discomfort and increase circulation and energy flow. I agree to communicate all physical concerns with my practitioner. *

Agree Disagree

PRODUCT RETURN GUIDELINES

Please indicate below that you agree to the following:

Caribbean Day Spa Skin Script Products and other Professional Products, are active formulas designed to treat skin conditions. Stimulating sensations are normal with product application but should not be painful. If a reaction should occur, it would be necessary to make an appointment with your consulting Skin Care Specialist prior to an exchange or return of any products. All returns must be made within 15 days of purchase for exchange or spa credit only. *

Agree Disagree

RESCHEDULING GUIDELINES

Please indicate below that you agree to the following:

A 24-hour rescheduling notice is appreciated and required. We realize emergencies happen and will be understanding if a last minute change arises; however, we reserve the right to charge full treatment price for missed appointments without a 24 hour notice. When scheduling spa packages, a 50% deposit is required to reserve services and are non-refundable in the case of cancellation without prior notice. *

Agree Disagree

PHOTOGRAPHS: (optional)

If you give permission please agree below:

I give permission for photographs to be used by the technician for educational purposes. Complete patient confidentiality will be maintained. The patient’s name or any other identifying information will be withheld. I consent to the publishing of photographs as long as my identity is concealed. *

Agree Disagree

Concent for Current and Future Treatments:

By signing below, I hereby consent to the Caribbean Day Spa clinical facial treatment and my signature shall serve as my consent to future treatments.

Name *

First Name Last Name

Signature: *

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Today's Date: *

Date

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