spa intake form template

Client Registration and Informed Consent Agreement

Instructions for Use

• Complete all sections of this form accurately prior to receiving any services at [Facility Name].
• Discuss any specific health concerns, allergies, or medical conditions with your practitioner before treatment begins.
• Sign and date the acknowledgment section at the bottom to confirm your understanding of the facility's policies and your consent to treatment.

Parties and Definitions

This agreement is entered into by and between [Facility Name], located at [Facility Address] ("Provider"), and the undersigned client:

Client Name: [] Date of Birth: [] Phone: [] Email: [] Emergency Contact Name & Phone: [__________]

Operative Clauses

1. Medical Disclosure: I certify that I have disclosed all relevant medical history, including but not limited to allergies, surgeries, current medications, pregnancy, or chronic conditions. I understand that it is my responsibility to inform the Provider of any changes to my health status in future sessions.

2. Informed Consent: I understand the nature of the services to be provided, including potential benefits and risks. I acknowledge that these services are for [relaxation / therapeutic / aesthetic] purposes and are not a substitute for medical diagnosis or treatment by a licensed physician.

3. Cancellation Policy: I agree to provide at least [__] hours' notice for any appointment cancellations. Failure to provide sufficient notice may result in a fee of [__________] or the forfeiture of any prepaid service credits.

4. Code of Conduct: I understand that this facility maintains a professional environment. Any illicit or suggestive remarks, advances, or inappropriate behavior will result in the immediate termination of the session and potential barring from future services.

5. Assumption of Risk: I voluntarily assume all risks associated with the services provided. I hereby release [Facility Name], its owners, and its employees from any liability, claims, or demands arising out of or related to any loss, damage, or injury that may be sustained while on the premises or during the provision of services.

6. Privacy Policy: My personal information will be kept confidential and will not be shared with third parties without my express written consent, except as required by law.

Signature and Acknowledgment

I have read the terms above and agree to comply with the policies of the facility. I certify that the information provided in this document is true and accurate.

Signature: __________

Printed Name: [__________]

Date: [__________]

Legal Disclaimer: This document is a general framework intended for informational purposes only. It does not constitute legal advice. Laws regarding health services, liability waivers, and consumer privacy vary significantly by jurisdiction. Consult with qualified legal counsel to ensure this document complies with all applicable local, state, and federal regulations.