The client consent to service and health history form is required to be filled out before your service time.

It is required once a year, or if there is any changes in your medical history. 

Consent to Service and Health History Form

Please fill out the following form before your appointment time.

Please fill out the following health and history information

If you are under specific care of a health practitioner, please fill out the following information

Please check if you have any of the following conditions

I understand that the services given to me are done by a licensed professional. I could experience moderate degrees of redness, burning, peeling, itching, and downtime, especially in the initial stages of the treatment program. These symptoms are normal and will eventually subside as my skin builds tolerance and heals. I understand that it is my choice to receive treatment by an esthetician, advanced aesthetician, nail technician or hair stylist, and massage therapist.

Treatments are given to me for the benefit of my wellbeing, mind and body. This includes stress reduction, relief of muscular tension, spasm or pain, or for increasing circulation or energy flow. When receiving a massage, I agree to communicate with my therapist any time I feel like my wellbeing is being compromised.

Because these services should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions asked of me honestly. Additionally, I understand that my service provider does not diagnose any physical or mental disorder or disease, nor do they prescribe medical treatment, pharmaceuticals, or spinal thrust manipulations. I agree to keep my provider updated as to any changes in my medical profile and I understand that there shall be no liability on them should I fail to do so. Further, I understand I am paying for a treatment and not a result and that there will be no returns, refunds or exchanges for the product given. Further, I understand that Spa bliss reserves the right to administer services at their sole discretion. I understand that Spa bliss does have policies regarding cancellations and no-showing appointments, and that I may be charged if I do not abide by these policies that I have agreed to. I understand that my card is saved on file, and that it will be charged if I do not abide by these policies. I have read and fully understand this form in entirety. If at any time there are changes in the information I have given, or in my condition, I will notify Spa bliss and update this form before receiving additional treatments.

Thanks for submitting!

Minor Consent