Massage Intake Form

For your safety and to ensure the best waxing experience, please complete the form below prior to your waxing appointment.

Name *
Are you currently pregnant? *
Please indicate any of the following that applies to you. *
By signing below, you agree to the following. I have completed this form to the best of my ability and knowledge and agree to inform my therapist if any of the above information changes at any time. Please note that massages does have certain side effects such as tenderness, etc. I have read the above information and if I have any concerns, I will address these with my skin therapist. I give permission to my therapist to perform the therapeutic massage booked or discussed, and will hold her and her staff harmless from any liability that may result from this treatment. I have given an accurate account of the questions asked below including all known allergies or prescription drugs or products I am currently ingesting or using topically. I understand my massage therapist will take every precaution to minimize or eliminate discomfort as much as possible. I agree that this constitutes full disclosure and that it supersedes any previous verbal or written disclosures. By completing this form, I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks. Services and products are non-refundable. I do not hold the massage therapist or Bare Skin, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed during scheduled appointment(s).