spa intake form pdf

Client Health History and Service Consent Form

Instructions for Use

• Complete all sections of this document accurately to ensure your service provider has the necessary information to safely perform your treatment.
• Review the numbered terms and conditions carefully, as they outline the legal obligations and service policies of the establishment.
• Sign and date the document at the bottom; if you are a minor, a parent or legal guardian must provide authorization.

Parties and Definitions

This agreement is between [Client Full Name] ("Client") and [Company Name] ("Service Provider"). Client Date of Birth: [] Emergency Contact Name: [] Emergency Contact Phone: [__________]

Operative Clauses

1. Health History Disclosure: Client represents that all health information provided is accurate and complete. Client agrees to inform the Service Provider of any changes in health status, including pregnancy, surgery, or new medications, prior to any future service.
2. Informed Consent: Client acknowledges that they have been informed of the nature of the services provided, including potential risks, side effects, and expected outcomes. Client voluntarily assumes all risks associated with the treatment.
3. Contraindications: Client confirms they have disclosed all known allergies, skin conditions, or medical restrictions. Service Provider reserves the right to refuse service if it is deemed medically inadvisable for the Client.
4. Cancellation and No-Show Policy: Client agrees to provide at least [] hours' notice for cancellations. Failure to provide timely notice may result in a fee equal to []% of the scheduled service cost.
5. Limitation of Liability: To the maximum extent permitted by law, Service Provider shall not be liable for any indirect, incidental, or consequential damages arising from services rendered, except in cases of gross negligence or willful misconduct.
6. Privacy and Data Protection: Service Provider agrees to maintain the confidentiality of all personal and medical data collected, in accordance with applicable local and federal privacy regulations.

Signature and Acknowledgment

By signing below, I certify that I have read, understood, and agreed to the terms outlined above.

Signature: __________ Printed Name: [] Title (if signing for minor): [] Date: [__________]

Legal Disclaimer

This document is a general framework intended for informational purposes only. It does not constitute legal advice. Because service industry regulations and privacy laws vary significantly by jurisdiction, you must consult with qualified legal counsel to ensure this document complies with all applicable local, state, and federal requirements.